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Incidental Findings Suggestive of COVID-19 Pneumonia in Oncologic Patients Undergoing 18F-FDG PET/CT Studies: Association Between Metabolic and Structural Lung Changes

Cristina Gamila Wakfie-Corieh, Federico Ferrando-Castagnetto, Alba María Blanes García, Marta García García-Esquinas, Aída Ortega Candil, Cristina Rodríguez Rey, María Nieves Cabrera-Martín, Ana Delgado Cano and José Luis Carreras Delgado
Journal of Nuclear Medicine February 2022, 63 (2) 274-279; DOI: https://doi.org/10.2967/jnumed.121.261915

Article Figures & Data

Figures

  • Figure
  • FIGURE 1.
    FIGURE 1.

    An 86-y-old woman with second primary lung tumor (B and C, blue arrow) referred for PET/CT to assess therapeutic response. Maximum-intensity projection (A) and axial sections with lung window (B) and fusion (C) images showed several pulmonary consolidations located mainly in right inferior lobe (red arrows, CO-RADS 5), with increased 18F-FDG uptake (SUVmax, 4.6). rRT-PCR was positive for COVID-19.

  • FIGURE 2.
    FIGURE 2.

    Staging PET/CT of 43-y-old woman with breast cancer (A, blue arrow). Maximum-intensity projection (A) and axial sections with lung window (B) and fusion (C) images show bilateral ground-glass pulmonary infiltrates (red arrows), some of them with pseudonodular morphology, located in both lower lobes and left middle lobe, with diffuse or peripheral distribution (SUVmax, 7.8). Early rRT-PCR obtained in emergency department was negative for COVID-19, and second test was not available.

  • FIGURE 3.
    FIGURE 3.

    Association of molecular and structural findings observed on multimodal imaging. SUVmax is compared among cancer patients of different CO-RADS categories.

  • FIGURE 4.
    FIGURE 4.

    Receiver-operating-characteristic curve of SUVmax to detect COVID-19 pneumonia on basis of structural tomographic diagnosis (CO-RADS 5 and 6).

Tables

  • TABLE 1.

    Clinical, Oncologic, and Biochemical Characterization of Study Population

    VariableGroup 1 (n = 16)Group 2 (n = 25)P
    Clinical
     Age (y)69.8 ± 13.564.7 ± 14.90.28
     Male sex15 (60.0)7 (43.8)0.15
    Oncologic
     Cancer staging5 (12.2)7 (17.1)> 0.99
     rt-PCR or serologic confirmation*10 (24.4)3 (7.3)0.0014
    Biochemical†
     Serum C reactive protein (mg/mL)7.5 ± 8.74.4 ± 8.40.45
     Lymphocyte blood count (per mm3)1.4 ± 0.71.2 ± 0.60.44
     Serum alanine aminotransferase (mg/mL)18.6 ± 6.519.3 ± 4.80.82
     Serum aspartate aminotransferase (mg/mL)27.6 ± 12.822.3 ± 6.30.33
     Serum lactate dehydrogenase (mg/mL)586.1 ± 204.6473.0 ± 163.80.22

    • *One patient with diagnosis of COVID-19 infection was confirmed by serologic IgG test (enzyme-linked immunosorbent assay).

    • ↵†Analytics were available for patients sent to emergency department with high or very high suspicion based on CO-RADS categories.

    • Qualitative data are number and percentage; continuous data are mean ± SD.

  • TABLE 2.

    Potential Usefulness of Different Cutoffs for 18F/FDG PET/CT SUVmax to Confirm or Eliminate Possibility That Tomographic Diagnosis of COVID-19 Exists

    SUVmax cutoffSensitivity (%)95% CI (%)Specificity (%)95% CI (%)LRAccuracy (%)
    <2.4524.011.5–43.493.871.7–99.73.892.9
    <2.5524.011.5–43.487.564.0–97.81.986.7
    <2.8532.017.2–51.681.357.0–93.41.780.7
    <3.1036.020.3–55–575.050.5–89.81.474.5

    • LR = likelihood ratio.

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