18F-FDG PET/CT findings of COVID-19: a series of four highly suspected cases

Abstract

Purpose: The aim of this case series is to illustrate the ¹⁸F-FDG PET/CT findings of patients with acute respiratory disease caused by COVID-19 in Wuhan, Hubei province of China.

Methods: We describe the ¹⁸F-FDG PET/CT results from four patients who were admitted to the hospital with respiratory symptoms and fever between January 13 and January 20, 2020, when the COVID-19 outbreak was still unrecognized and the virus infectivity was unknown. A retrospective review of the patients' medical history, clinical and laboratory data, as well as imaging findings strongly suggested a diagnosis of COVID-19.

Results: All patients had peripheral ground-glass opacities and/or lung consolidations in more than two pulmonary lobes. Lung lesions were characterized by a high ¹⁸F-FDG uptake and there was evidence of lymph node involvement. Conversely, disseminated disease was absent, a finding suggesting that COVID-19 has pulmonary tropism.

Conclusions: Although ¹⁸F-FDG PET/CT cannot be routinely used in an emergency setting and is generally not recommended for infectious diseases, our pilot data shed light on the potential clinical utility of this imaging technique in the differential diagnosis of complex cases.

Keywords: 18F-FDG PET/CT; Acute respiratory disease; COVID-19; Consolidative opacities; Ground-glass opacities; Infection; SARS-CoV-2.

Fig. 1

Peripheral GGOs with an increased ¹⁸F-FDG uptake in the right upper lung and left lower lung

Fig. 2

Multiple FDG-positive GGOs and consolidative opacities in both lungs as well as multiple FDG-avid lymph nodes in the mediastinum and the subclavian region

Fig. 3

Multiple peripheral FDG-avid GGOs in the right lung and multiple FDG-positive nodes in the mediastinum and the right subclavian region

Fig. 4

Peripheral FDG-avid GGOs with interlobular septal thickening in both lungs and multiple FDG-positive lymph nodes in the mediastinum and right hilar region