18F-FDG PET/CT and COVID-19

European Journal of Nuclear Medicine and Molecular Imaging -     

FDG-PET/CT findings highly suspicious for COVID-19 in an Italian case series of asymptomatic patients

European Journal of Nuclear Medicine and Molecular Imaging - To illustrate the [18F]FDG-PET/CT findings in patients affected by cancer with clinical diagnosis of Covid-19 We retrospectively...     

18F-FDG PET/CT在新型冠状病毒肺炎诊断中的应用

新型冠状病毒肺炎（COVID-19）被发现以来,迅速蔓延,其早期诊断有利于患者的及时救治和疾病进一步传播的有效控制。目前,诊断的依据是流行病史、临床表现、影像学特征和逆转录聚合酶链式反应（RT-PCR）检测结果,其中RT-PCR检测到新型冠状病毒核酸阳性是COVID-19确诊的主要依据,影像学特征尤其是肺部高分辨率CT表现则是诊断该病的重要临床依据。作为一种被广泛应用的影像学方法,18F-FDG PET/CT在COVID-19中的价值仍未可知。笔者分析了18F-FDG PET/CT在COVID-19中的诊断和鉴别诊断的价值,以及评估COVID-19患者纵隔淋巴结受累情况方面的潜在应用,讨论了COVID-19患者肺外器官和组织受累可能出现的18F-FDG PET/CT影像学表现。     

18F FDG-PET/CT findings in recurrent respiratory papillomatosis

Recurrent respiratory papillomatosis (RRP) is an indolent and primary disease of the larynx and the trachea and rarely extends to smaller airways. F-18 fluoro-2-deoxy-D-glucose positron emission tomography and computed tomography (FDG-PET/CT) evaluation in this condition has not been reported earlier. We report FDG-PET/CT findings in a case of RRP that included a large papillomatous lung mass resembling cancer.     

Anatomo-metabolic characteristics of atelectasis in F-18 FDG-PET/CT imaging

PURPOSE: To evaluate the structural and metabolic characteristics of atelectasis in FDG-PET/CT. METHODS: Twenty one consecutive patients (13 males, 8 females, median age 67 years) with CT features of atelectasis, undergoing PET/CT imaging for preoperative staging of histologically proven malignancies (20 lung cancer and 1 ovarian cancer metastasis to lung), were included in the study. RESULTS: Hounsfield units of atelectasis (-383.58+/-189, range -631 to 82) were significantly higher than in normal lung (-756+/-67.46, range -839 to -555; P=0.0001), and lower than in malignant tissue (35+/-19, range 4-77; P=0.0001). The main patterns of FDG uptake observed in atelectasis were diffuse and homogenous. The standard uptake value (SUV) in atelectasis was low to moderate (SUV(avg): 1.13+/-0.50; SUV(max): 1.44+/-0.54), and generally lower than in tumor tissue (SUV(avg): 6.25+/-3.58, range 2.0-16.5), but always higher than in normal lung (0.56+/-0.18 and 0.70+/-0.23, respectively) (P=0.0001). There was a positive correlation between the density of atelectatic lesions and the degree of uptake, with no relationship to size. CONCLUSION: There is a positive relationship between the density of collapsed lung and the intensity of FDG uptake. FDG uptake in atelectasis is higher than in normal lung, and generally lower than in tumor tissue.     

Rubidium-82 PET/CT in COVID-19

A 56-year-old man presented to the emergency department with shortness of breath during the COVID-19 pandemic. Chest computed tomography angiography (CTa) showed bilateral peripheral ground-glass opacifications classified as CO-RADS 5, but no pulmonary embolism. To analyze the possibility of CTa-undetectable pulmonary microthrombi and to rule out cardiac perfusion abnormalities, we decided to perform a rubidium-82 (⁸²Rb) PET/CT. ⁸²Rb PET/CT imaging in this patient yielded uptake in the pulmonary areas of ground-glass opacification and showed corresponding findings between ⁸²Rb PET/CT and CTa imaging without any signs of microthrombi despite the elevated d-dimer. Even in the areas of profound groundglass opacifications, the increased ⁸²Rb uptake indicates that perfusion is adequate to acquire ⁸²Rb uptake in the pulmonary cells. ⁸²Rb PET/CT is a promising imaging technique and might extend the diagnostic potential of conventional nuclear and radiological imaging in detecting pulmonary microthrombi or other minor perfusion defects.     

Diagnosis of Cardiac Metastasis from Endometrial Cancer by F-18 FDG-PET/CT

We report a case of a 59-year-old woman with right ventricular metastasis of undifferentiated endometrial cancer. Cardiac metastasis from endometrial cancer is a very rare finding. The case demonstrates that undifferentiated endometrial cancer is capable of metastasizing, presumably through a hematogenous route, to unexpected distant organs. These unexpected sites should not be undermined in the restaging and surveillance of these patients.     

F-18 FDG-PET/CT in evaluation of patients with fever of unknown origin

Objectives

This study was carried out to evaluate the diagnostic utility of FDG-PET/CT in patients with fever of unknown origin (FUO).

Methods

Medical records of 103 patients who underwent FDG-PET/CT and anatomic imaging as a part of FUO workup were analyzed. Final diagnosis of the cause of FUO was reached based on serologic assays, cultures, biopsy, surgery or 6 months of clinical follow-up.

Results

The definite cause of fever was established in 69/103 patients. Abnormal FDG uptake was found in 63/103 patients and contributed to the final diagnosis (TP) in 62 patients (98.48 %). Of the remaining 40 patients with negative PET/CT, the final definite cause of fever (FN) could be determined only in seven patients (17.5 %). PET/CT had a sensitivity, specificity, positive predictive value and negative predictive value of 90, 97, 98.4 and 82.5 % compared to 43.5, 67.6, 73.2 and 37.1 %, respectively, for anatomic imaging. FDG-PET/CT had a higher accuracy (92.2 vs. 51.5 %; p = 0.003) compared to anatomic imaging for suggesting a cause of FUO.

Conclusions

PET/CT showed high sensitivity and specificity in suggesting a definite diagnosis in the evaluation of FUO.     

COVID-19 radiology CT personnel management

A new coronavirus outbreak called COVID-19 started in December 2019. In Turkey, the first case was reported on 10 March 2020. In this article, information will be given about the patient and staff management and organization that we have implemented in the Radiology Department of our hospital during the COVID-19 pandemic. The rules we followed were: 1- Performing the examinations of COVID-19 patients and suspects with a CT device isolated from other patients; 2- Reducing the unnecessary workload in imaging modalities other than CT, emergency radiography, and emergency ultrasonography; 3- Directing and managing patients and their relatives in accordance with the mask and distancing rules; 4- Disinfecting the device with an appropriate disinfectant after each patient in order to prevent cross-contamination; 5- Protecting the entire technician team from infection by employing one week work, two weeks off shifts of fixed teams; 6- Ensuring adequate ventilation of the gantry room. Adhering to the above rules, no infection spread was reported from the Radiology department and especially the COVID-19 CT unit.

In December 2019, a new coronavirus outbreak called COVID-19 was reported in China (1). On March 11, 2020, the World Health Organization (WHO) announced that it became a pandemic (2), and the incubation period of the disease was reported to be in the range of 2 to 10 days (3). Later, it became evident that the virus caused a highly contagious disease by transmitting from person to person through respiratory droplets and from surfaces contaminated with the virus (4–6), and that the incubation period can vary between 1 and 19 days (7). In Turkey, the first case was detected on 10 March 2020. The National Coordination Board also convened on the same day. Like most countries, our country has set targets within the framework of the following strategies in combating the epidemic. These strategies are: 1) slowing and halting disease spread, preventing epidemics and delaying the spread; 2) providing optimized care for all patients, especially those with severe diseases; and 3) minimizing the impact of the epidemic on health systems, social services and economic activity (8). After the coordination board meeting, a series of measures were taken by the Ministry of Health in our country to prevent the spread of COVID-19. In this context, by using all media channels in our country, both the public and the health personnel were informed about the disease; announcements were made about the hygiene rules and trainings were started. Those with a travel history abroad were quarantined for 14 days, even if they did not have symptoms of the disease. If symptoms occurred in these individuals, possible case management algorithms were applied (9). Like all institutions, pandemic committees have been established in our hospital and necessary measures have been taken. While only preventive measures were taken to limit the spread of COVID-19 in non-healthcare-related institutions, the planning in hospitals is not one-sided, and requires multi-directional and comprehensive planning. All diagnostic and treatment-related services in hospitals should be reorganized to prevent the transmission of the virus from patient to patient, patient to patient relatives, patient to staff and staff to patients. In this context, serious changes need be made in the management of patients and personnel to ensure the continuity of work in the Radiology departments throughout the epidemic. In other words, while providing services to COVID-19 patients, the risk of transmitting the disease to other patients and staff should be minimized (10). In this article, we summarize the patient and personnel management and organization that we have implemented in the Radiology Department of Ege University hospital during the COVID-19 outbreak.     

Current clinical use of 18FDG-PET/CT in patients with thoracic and systemic sarcoidosis

Purpose

This study assessed the role of whole-body ¹⁸fluorodeoxyglucose positron-emission tomography/computed tomography (¹⁸FDG PET/CT) in the restaging and follow-up of patients with sarcoidosis previously studied by multidetector computed tomography (MDCT).

Materials and methods

This retrospective study enroled 21 patients to evaluate the sensitivity, specificity and accuracy of ¹⁸FDG-PET/CT and MDCT. The results of the two techniques were compared with the Mc Nemar test. Cohen’s K was used to compare concordance at the different lesion sites.

Results

The sensitivity, specificity and accuracy of ¹⁸FDG-PET/CT were 80, 66.67, and 76.19 %, respectively. The sensitivity, specificity and accuracy of MDCT were 93.33, 33.33, and 76.19 %, respectively. In 16 patients who underwent whole-body MDCT, the sensitivity, specificity and accuracy values were 91.67, 81.25, and 50 % (MDCT) and 100, 50, and 87.5 % (¹⁸FDG-PET/CT).

Conclusions

¹⁸FDG-PET/CT is useful in evaluating the extent of sarcoidosis and recognising lesions at different sites, including lymph nodes, lungs, liver, spleen and bone. It also improves the interpretation of the morphological lesions seen on MDCT and depicts a larger number of lesions. Therefore, ¹⁸FDG-PET/CT could be used to complement other more traditional techniques for the restaging and follow-up in patients with sarcoidosis.     

FDG-PET/CT imaging of elastofibroma dorsi

Objective  

The purpose of this study was to assess retrospectively the characteristics of FDG uptake in elastofibroma dorsi using integrated PET/CT.     

Assessment of liver metastases from colorectal adenocarcinoma following chemotherapy: SPIO-MRI versus FDG-PET/CT

Purpose

This study compared superparamagnetic iron-oxide-enhanced magnetic resonance imaging (SPIO-MRI) and combined fluorodeoxyglucose positron emission tomography and computed tomography (FDG-PET/CT) in evaluating liver metastases from colorectal adenocarcinoma following chemotherapy.

Materials and methods

Nineteen patients were included in this retrospective study. SPIO-MRI and PET/CT results were compared with surgery, intraoperative ultrasound and pathology results in 11 patients and with the follow-up in eight patients.

Results

SPIO-MRI and PET/CT identified 125 and 71 metastases, respectively. False negative lesions were 11 for SPIO-MRI and 65 for PET/CT. In the whole study population, the per-lesion analysis of SPIO-MRI and PET/CT showed a sensitivity of 92% and 52% (p<0.001) and the per-segment analysis a sensitivity of 99% and 79% (p<0.001), respectively. In patients who underwent surgery, the per-lesion analysis of SPIO-MRI and PET/CT showed a sensitivity of 85% and 58% (p<0.05) and the per-segment analysis a sensitivity of 97% and 63% (p<0.05), respectively. In patients who underwent follow-up, the per-lesion analysis of SPIO-MRI and PET/CT showed a sensitivity of 97% and 47% (p<0.001) and the per-segment analysis a sensitivity of 100% and 63% (p<0.007), respectively. For lesions ≥15 and <30mm and for lesions <15 mm, SPIO-MRI demonstrated a higher sensitivity than PET/CT (p<0.001).

Conclusions

SPIO-MRI appears superior to PET/CT in evaluating liver metastases from colorectal adenocarcinoma following chemotherapy.     

Perfusion SPECT/CT to diagnose pulmonary embolism during COVID-19 pandemic

European Journal of Nuclear Medicine and Molecular Imaging -