COVID-19 and Nuclear Medicine: what we know so far…

Sudhir Bhimaniya; Adeel Haq; Chadwick Barrs; Maria Ponisio

Abstract

2663

Introduction: Awareness with possible COVID-19 related findings in nuclear medicine imaging studies is essential in ongoing pandemic. A pictorial review of common and unusual COVID-19 findings in patients imaged for oncological or non-oncological indications with multimodaity nuclear medicine studies is presented.

Methods: A retrospective study of patients with Nuclear Medicine (NM) imaging and confirmed COVID-19 diagnosis was performed between January 2020 and December 2021. We reported relevant COVID-related findings in several NM methodologies, including positron emission computed tomography (PET/CT), nuclear cardiac, ventilation-perfusion, hepatobiliary, gastric emptying, and brain perfusion scans. We reviewed clinical and laboratory COVID-19 related results, vaccination status. A systematic analysis of the NM imaging findings was performed to assess possible COVID-19 associated changes in the organs, and common and incidental imaging findings were noted.

Results: A literature review and critical teaching points of the findings in planar and PET images are presented. Representative cases include FDG-avid lung findings,vaccine-related local and systemic inflammatory response, myocarditis, and myocardial dysfunction seen on nuclear medicine functional cardiac studies, gastrointestinal manifestations in emptying studies, and abnormal metabolism associated with neurological manifestation.

Conclusions: COVID-19 infection and its sequaelae can affect almost any organ system and may present as unexpected confounders in the interpretation of nuclear imaging studies performed for other indications in oncological or non-oncological patients. It is crucial to recognize these findings to avoid misdiagnoses that may have critical downstream implications, particularly for staging, prognostication, and treatment in malignancies. It is also important to correlate the incidental findings with patient histories such as recent infection or vaccination to avoid unnecessary evaluation or interventions.