Assessment of extra-parenchymal lung involvement in asymptomatic cancer patients with COVID-19 pneumonia detected on 18 F-FDG PET-CT studies

Lung involvement in patients with coronavirus disease 2019 (COVID-19) undergoing PET-CT has been previously reported. However, FDG uptake outside lung parenchyma was poorly characterized in detail. We evaluated the extra-parenchymal lung involvement in asymptomatic cancer patients with COVID-19 pneu...

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Veröffentlicht in:European journal of nuclear medicine and molecular imaging 2021-03, Vol.48 (3), p.768
Hauptverfasser: Wakfie-Corieh, Cristina Gamila, Blanes García, Alba María, Ferrando-Castagnetto, Federico, Valhondo-Rama, Raquel, Ortega Candil, Aida, Rodríguez Rey, Cristina, Cabrera Martín, María Nieves, García-Esquinas, Marta García, Couto Caro, Rosa María, Pedrera Canal, María, Carreras Delgado, José Luis
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Sprache:eng
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Zusammenfassung:Lung involvement in patients with coronavirus disease 2019 (COVID-19) undergoing PET-CT has been previously reported. However, FDG uptake outside lung parenchyma was poorly characterized in detail. We evaluated the extra-parenchymal lung involvement in asymptomatic cancer patients with COVID-19 pneumonia through F-FDG PET-CT. A total of 1079 oncologic F-FDG PET-CT were performed between February 2 and May 18, 2020. Confirmed COVID-19 pneumonia was defined as characteristic ground-glass bilateral CT infiltrates and positive genetic/serologic tests. Nonmetastatic extra-parenchymal lung PET-CT findings were evaluated through qualitative (visual), quantitative (measurements on CT), and semiquantitative (maximum standardized uptake value: SUVmax on PET) interpretation. Clinical data, blood tests, and PET-CT results were compared between patients with and without COVID-19 pneumonia. A total of 23 F-FDG PET-CT scans with pulmonary infiltrates suggestive of COVID-19 and available laboratory data were included: 14 positive (cases) and 9 negative (controls) for COVID-19 infection, representing a low prevalence of COVID-19 pneumonia (1.3%). Serum lactate dehydrogenase and D-dimers tended to be increased in COVID-19 cases. Extra-parenchymal lung findings were found in 42.9% of patients with COVID-19, most frequently as mediastinal and hilar nodes with F-FDG uptake (35.7%), followed by incidental pulmonary embolism in two patients (14.3%). In the control group, extra-pulmonary findings were observed in a single patient (11.1%) with F-FDG uptake located to mediastinal, hilar, and cervical nodes. Nasopharyngeal and hepatic SUVmax were similar in both groups. In cancer patients with asymptomatic COVID-19 pneumonia, F-FDG PET-CT findings are more frequently limited to thoracic structures, suggesting that an early and silent distant involvement is very rare. Pulmonary embolism is a frequent and potentially severe finding raising special concern. PET-CT can provide new pathogenic insights about this novel disease.
ISSN:1619-7089