18 F-FDG PET/CT in asymptomatic patients with COVID-19: the submerged iceberg surfaces
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SPECIAL REPORT
18
F‑FDG PET/CT in asymptomatic patients with COVID‑19: the submerged iceberg surfaces
Marzia Colandrea1 · Laura Gilardi1 · Laura L. Travaini1 · Silvia L. V. Fracassi1 · Luigi Funicelli2 · Chiara M. Grana1 Received: 15 April 2020 / Accepted: 14 June 2020 © Japan Radiological Society 2020
Abstract Objective The aim of this case series is to describe our experience in diagnosis and management of oncological asymptomatic patients with COVID-19 who underwent 18F-FDG PET/CT. Methods From March 9 to March 31, 2020, we identified 5 patients who had PET/CT findings suspicious for COVID-19, but no symptom of infection. Results The first three patients were administered an SARS-CoV-2 test in a COVID-dedicated center, while the fourth and fifth were tested in our institution, in accordance with a new internal procedure. The SARS-CoV-2 test yielded positive results in all five patients. Conclusion In this COVID-19 emergency, our task as radiologists and nuclear medicine physicians is to be able to identify imaging findings suggestive of the disease and to manage patients without overloading the hospital system. Keywords COVID-19 · Asymptomatic patients · 18F-FDG PET/CT · Chest CT Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with its epicenter in the Hubei Province of the People’s Republic of China, has spread to many countries and is officially a pandemic. To date, Italy has been one of the most affected countries, in particular the Lombardy region. The Emergency Medical System (EMS) of the metropolitan area of Milan promptly responded to the rapid outbreak of the disease, creating a procedural algorithm aimed at handling suspected cases, adopting containment measures, and addressing population concerns [1]. As a hospital solely dedicated to cancer treatment and research, we are not at the forefront of this tough battle that is taking place in our country. However, consistent with the high spread of the disease, we diagnosed some unexpected Laura Gilardi and Marzia Colandrea have contributed equally to this paper as first authors. * Laura L. Travaini [email protected] 1
Division of Nuclear Medicine, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
Division of Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy
2
cases during the execution of 18F-FDG PET/CT between March 9 and March 31, 2020. Common clinical manifestations of COVID-19 include fever, cough, dyspnoea, myalgia, and fatigue. None of our patients had symptoms of infection. The first two patients were a 54-year-old man who was referred to our division for the staging of a non-Hodgkin lymphoma, and a 61-year-old man who presented lung, lymph nodes, and brain lesions suspected for cancer of unknown primary origin. In patient #1, the PET/CT scan revealed pathological uptake in right inguinal lymph nodes (Fig. 1a—box). There was also intense 18F-FDG uptake on multiple bilateral subsegmental peripheral patchy ground-glass op
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