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. 2022 Winter;10(1):57-63.
doi: 10.22038/AOJNMB.2021.58035.1405.

18F-FDG PET-CT incidental lung findings in asymptomatic COVID-19 patients: evidences from the Italian core of the first pandemic peak

Bonanomi Alice  1   2 , Bonaffini Pietro Andrea  1   2 , Spallino Marianna  3 , Dulcetta Ludovico  1   2 , Franco Paolo Niccolò  1   2 , Valle Clarissa  1   2 , Marra Paolo  1   2 , Bruno Andrea  3 , Sironi Sandro  1   2
Affiliations

18F-FDG PET-CT incidental lung findings in asymptomatic COVID-19 patients: evidences from the Italian core of the first pandemic peak

Bonanomi Alice et al. Asia Ocean J Nucl Med Biol. 2022 Winter.

Abstract

Objectives: To illustrate incidental 18F-FDG PET-CT findings and related CT alterations of suspicious pulmonary interstitial involvement in asymptomatic oncologic patients during the first COVID-19 outbreak in the core of Italian peak.

Methods: We retrospectively evaluated the 18F-FDG PET-CT follow-up examinations performed during the first Italian COVID-19 outbreak (March 3rd-April 15th, 2020) in 10 asymptomatic oncologic patients with a highly suspicious interstitial pulmonary involvement on CT. Six cases were confirmed SARS-CoV-2 by molecular tests. The following parameters were assessed: 1) lung involvement on co-registration CT as extension (laterality, number of lobes), pattern (ground-glass opacities/GGO, consolidations, mixed) and stage (early, progressive, peak, and absorption); 2) the maximum standardized uptake value (SUVmax) of lung lesions on 18F-FDG PET.

Results: The involved lobes were 5 in 5 cases (3 confirmed SARS-CoV-2), 2-4 in 4 cases and 1 in 1 case. GGO were found in all patients; 3 cases also showed a combination of GGO and peripheral consolidations (mixed). Five cases were suggestive for an early stage of interstitial pneumonia, 4 for progressive and 1 for peak. All the lung lesions showed increased FDG uptake. In early stages SUVmax ranged from 1.5 to 11, in progressive from 3.3 to 6.8, in peak from 2.4 to 7.7. SUVmax ranged 1.5-11 in patients with only GGO and 2.8-7.7 in those with mixed pattern.

Conclusions: 18F-FDG PET-CT findings in suspected COVID-19 pulmonary involvement of asymptomatic oncologic patients showed an increase in FDG uptake of GGO and consolidations, but with a wide and apparently nonspecific range of SUVmax values.

Keywords: Asymptomatic; COVID-19; FDG uptake; Interstitial pneumonia; PET-CT.

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Figures

Figure 1
Figure 1
CT (a) and PET-CT (b) images from a 57 years old female in semestral follow-up for a nasopharyngeal cancer and asymptomatic at the moment of the acquisition. In the co-registration CT (a) there are bilateral GGO in the right and left upper lobes (black arrows); no consolidation are noted, resulting in an early stage. These GGO demonstrate intense FDG uptake (b), with SUVmax in the right lobe of 11.02 and SUVmax in the left lobe of 6, 72. Otherwise, PET was negative
Figure 2
Figure 2
Female, 72 years old, with urothelial cancer. Axial CT image (a) shows bilateral compact consolidations (black arrows), mixed with peripheral GGO and reticulation (red arrows) and right pleural effusion (black arrowhead); findings consistent with a peak stage. On corresponding PET scan (b) SUVmax of the nodular consolidation adjacent to the pleural effusion was 7.7. The patient was a poorly compliant patient, but the family members did not report any symptom in the days before the scan
See this image and copyright information in PMC

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