Diagnostic challenges of incidental lung lesions on liver MRI during the COVID-19 pandemic

The CT uncovered multiple ground glass opacities in a bilateral, multilobar and peripheral distribution, corresponding to the British Society of Thoracic Imaging classification of, classic/probable COVID-19 infection.3 Figure 2 shows the CT. The lack of sensitivity of RT-PCR and the poor specificity of thoracic CT, which are currently the two most commonly used diagnostic tests for COVID-19 infection, make it difficult to draw definite conclusions about suspicious lesions on MRI.4 5 At the time of writing this report, all published examples of pulmonary COVID-19 on MRI are descriptive.6–8 The limited available data primarily from thoracic MRI, however, suggest that on liver and abdominal imaging protocols, COVID-19 presents as lung lesions with: high T1 signal due to partial alveolar collapse and higher tissue density, high T2 signal caused by oedema or consolidation, high DWI signal because of increased cell density from the inflammatory reaction and partial collapse, and with a heterogeneous enhancement pattern after contrast administration. There is a need for more reliable diagnostic tests and better descriptors of COVID-19 infection on common abdominal MRI sequences so that the correct management decisions can be made when incidental lesions are detected such as in the case of the patient described here.