Assessment of extra-parenchymal lung involvement in asymptomatic cancer patients with COVID-19 pneumonia detected on 18
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ORIGINAL ARTICLE
Assessment of extra-parenchymal lung involvement in asymptomatic cancer patients with COVID-19 pneumonia detected on 18F-FDG PET-CT studies Cristina Gamila Wakfie-Corieh 1 & Alba María Blanes García 1 & Federico Ferrando-Castagnetto 2 & Raquel Valhondo-Rama 1 & Aida Ortega Candil 1 & Cristina Rodríguez Rey 1 & María Nieves Cabrera Martín 1 & Marta García García-Esquinas 3 & Rosa María Couto Caro 1 & María Pedrera Canal 1 & José Luis Carreras Delgado 1 Received: 15 June 2020 / Accepted: 31 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Lung involvement in patients with coronavirus disease 2019 (COVID-19) undergoing PET-CT has been previously reported. However, FDG uptake outside lung parenchyma was poorly characterized in detail. We evaluated the extraparenchymal lung involvement in asymptomatic cancer patients with COVID-19 pneumonia through 18F-FDG PET-CT. Methods A total of 1079 oncologic 18F-FDG PET-CT were performed between February 2 and May 18, 2020. Confirmed COVID-19 pneumonia was defined as characteristic ground-glass bilateral CT infiltrates and positive genetic/serologic tests. Nonmetastatic extra-parenchymal lung PET-CT findings were evaluated through qualitative (visual), quantitative (measurements on CT), and semiquantitative (maximum standardized uptake value: SUVmax on PET) interpretation. Clinical data, blood tests, and PET-CT results were compared between patients with and without COVID-19 pneumonia. Results A total of 23 18F-FDG PET-CT scans with pulmonary infiltrates suggestive of COVID-19 and available laboratory data were included: 14 positive (cases) and 9 negative (controls) for COVID-19 infection, representing a low prevalence of COVID19 pneumonia (1.3%). Serum lactate dehydrogenase and D-dimers tended to be increased in COVID-19 cases. Extraparenchymal lung findings were found in 42.9% of patients with COVID-19, most frequently as mediastinal and hilar nodes with 18F-FDG uptake (35.7%), followed by incidental pulmonary embolism in two patients (14.3%). In the control group, extrapulmonary findings were observed in a single patient (11.1%) with 18F-FDG uptake located to mediastinal, hilar, and cervical nodes. Nasopharyngeal and hepatic SUVmax were similar in both groups. Conclusion In cancer patients with asymptomatic COVID-19 pneumonia, 18F-FDG PET-CT findings are more frequently limited to thoracic structures, suggesting that an early and silent distant involvement is very rare. Pulmonary embolism is a frequent and potentially severe finding raising special concern. PET-CT can provide new pathogenic insights about this novel disease. Keywords
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F-FDG . PET-CT . COVID-19 . SARS-CoV-2 . Cancer . Extra-parenchymal lung
Introduction This article is part of the Topical Collection on Infection and inflammation. * Cristina Gamila Wakfie-Corieh [email protected] 1
Department of Nuclear Medicine, Hospital Clínico San Carlos, Av. Profesor Martín Lagos s/n., 28040 Madrid, Spain
2
Department of Cardiology, Hospital de Clínica
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