key: cord-0961626-9tn9zg8t
authors: López-Mora, D. A.; Fernández, A.; Duch, J.; Carrio, I.
title: Follow-up 18F-FDG PET/CT in an oncological asymptomatic COVID-19 patient
date: 2021-03-06
journal: Revista espanola de medicina nuclear e imagen molecular
DOI: 10.1016/j.remnie.2021.03.005
sha: f35a04fbc4cfa802a77ba19af3951bb61bc1457c
doc_id: 961626
cord_uid: 9tn9zg8t

nan

F-FDG PET/CT performed did not show hypermetabolic lesions suspicious of local recurrence nor lymph nodes (including retroperitoneal territories) nor metastases. However, the study showed peripheral bilateral pulmonary hipermetabolic ground-glass opacities [1] predominantly in the superior lobes, suggestive of active pulmonary infectious disease (probably COVID-19 in the current pandemic context). When the baseline 18 F-FDG PET/CT was performed the patient was asymptomatic and we suggested him to undergo reverse transcription-polymerase chain reaction (RT-PCR) of the nasopharyngeal exudate, but the patient did not consult. After 5 days in "quarantine", the patient re-consulted due to symptoms compatible with pneumonia, being diagnosed by RT-PCR of SARS-COV-2 (Severe Acute Respiratory Syndrome Coronavirus 2, for its acronym). The patient received incomplete treatment with hydroxychloroquine and oxygenotherapy due to voluntary abandonment. Three months later, while the patient was asymptomatic, a follow-up 18 F-FDG PET/CT was performed, and showed multiple liver metastases (image 2-2b, blue arrows) and resolution of the bilateral hypermetabolic pulmonary opacities (image 2a).

This image highlights the usefulness of 18 F-FDG PET/TC in the early detection of asymptomatic patients with COVID-19 [1] and its potential utility in the follow-up of these group of patients. To the extent of our knowledge, no cases of follow-up 18 FDG-PET/CT have been reported in oncological patients with COVID-19. This image also highlights the good sensitivity of 18 F-FDG PET/CT to assess evolution and possible secuelae of SARS-COV-2. However, 18 F-FDG PET/CT is not recommended as a routine imaging modality as it is a technique with a high radiation dose and prolonged exam times, and with a possible risk of infectious diseases spreading [3] .

Medicina Nuclear en la pandemia por Covid-19

The potential added value of FDG PET/CT for COVID-19 pneumonia

18F-FDG PET/CT and COVID-19

68-year-old man with urothelial carcinoma in complete response after cystoprostatectomy and chemotherapy. Baseline 18 F-FDG PET/CT (image 1) showed multiple peripheral bilateral pulmonary hipermetabolic ground-glass opacities predominantly in superior lobes, suggestive of active pulmonary infectious disease (image 1a; red arrows), without other hypermetabolic lesions suggestive of malignancy (Image 1-1b). The follow-up 18 F-FDG PET/CT (performed 3 months after baseline PET/CT; image 2) showed resolution of the bilateral pulmonary ground-glass opacities (image 2a) and multiple hypermetabolic liver lesions suggestive of liver metastases (segment I and segment VIII; image 2b; blue arrows).

Hombre de 68 años diagnosticado de carcinoma urotelial libre de enfermedad tras cistoprostatectomía y quimioterapia. En el PET/TC con 18 F-FDG basal (imagen 1) únicamente destacan múltiples opacidades pulmonares bilaterales de densidad en vidrio deslustrado e hipermetabólicas predominantemente en lóbulos superiores, sugestivas de proceso inflamatorio/infeccioso de probable etiología vírica (imagen 1a; flechas rojas). No se observan otras lesiones hipermetabólicas sugestivas de malignidad (imagen 1-1b). En el estudio PET/TC con 18 F-FDG de control (a los 3 meses del PET/TC basal; imagen 2) se observa resolución de los infiltrados pulmonares bilaterales (imagen 2a) con aparición de múltiples lesiones hepáticas hipermetabólicas sugestivas de enfermedad metastásica, destacando las lesiones del segmento I y segmento VIII (imagen 2b; flechas azules).