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The Use of Positron Emission Tomography in Coronavirus Disease 2019 Cases

Open ArchivePublished:May 05, 2020DOI:https://doi.org/10.1016/j.jtho.2020.04.027
      An excellent visual demonstration was provided by Polverari et al.

      Polverari G, Arena V, Ceci F, et al. 18F-FDG uptake in asymptomatic SARS-CoV-2 (COVID-19) patient, referred to PET/CT for non-small cells lung cancer restaging [e-pub ahead of print]. J Thorac Oncol. https://doi.org/10.1016/j.jtho.2020.03.022, accessed April 23, 2020.

      of a novel coronavirus disease 2019 case on positron emission tomography (PET) combined with computed tomography (CT) using the radiotracer fluorodeoxyglucose. Along the same lines, the largest series published, primarily in English, on this topic is that of Qin et al.
      • Qin C.
      • Liu F.
      • Yen T.C.
      • Lan X.
      18F-FDG PET/CT findings of COVID-19: a series of four highly suspected cases.
      They also reported unmistakable changes on the PET and CT components. PET clearly complemented the CT findings in all cases (as described in both articles).
      The most common CT findings in those affected with coronavirus disease 2019 have been well described.

      Wang Y, Dong C, Hu Y, et al. Temporal changes of CT findings in 90 patients with COVID-19 pneumonia: a longitudinal study [e-pub ahead of print]. Radiology. https://doi.org/10.1148/radiol.2020200843, accessed April 23, 2020.

      It seems that in all of the PET–CT cases, these typical appearances were clearly apparent on the CT component (primarily ground-glass opacities, consolidation, or a combination of both) of the study and the PET findings were, realistically, a little superfluous. Although in these instances PET–CT played a role in supporting the diagnosis, it seems that the diagnosis would have been established with CT alone. Using CT alone would also have resulted in a lower radiation exposure.
      • Martí-Climent J.M.
      • Prieto E.
      • Morán V.
      • et al.
      Effective dose estimation for oncological and neurological PET/CT procedures.
      How much did the PET findings really contribute to the diagnosis? Was PET truly necessary? Would a CT scan have established the same outcome at a lower cost, lower radiation exposure, and greater efficiency?
      Having said that, how can PET be better used in this setting? Is it more useful potentially for follow-up purposes? In the same way as has been postulated with cardiac lymphoma, PET may be more useful for functionally assessing disease activity after treatment even in the presence of unresolved morphologic changes.
      • Lee J.C.
      • Platts D.G.
      • Huang Y.T.
      • Slaughter R.E.
      Positron emission tomography combined with computed tomography as an integral component in evaluation of primary cardiac lymphoma.
      Would this be a better use of PET for such patients? After all, as is common knowledge, pulmonary parenchymal changes may persist for quite a long time after resolution of respiratory infective symptoms.

      Acknowledgments

      Dr. Lee contributed to the conceptualization, writing, and original draft preparation of this work. Dr. Blazak contributed to the review and editing of this work. Drs. Lee and Blazak contributed to the visualization of this work.

      References

      1. Polverari G, Arena V, Ceci F, et al. 18F-FDG uptake in asymptomatic SARS-CoV-2 (COVID-19) patient, referred to PET/CT for non-small cells lung cancer restaging [e-pub ahead of print]. J Thorac Oncol. https://doi.org/10.1016/j.jtho.2020.03.022, accessed April 23, 2020.

        • Qin C.
        • Liu F.
        • Yen T.C.
        • Lan X.
        18F-FDG PET/CT findings of COVID-19: a series of four highly suspected cases.
        Eur J Nucl Med Mol Imaging. 2020; 47: 1281-1286
      2. Wang Y, Dong C, Hu Y, et al. Temporal changes of CT findings in 90 patients with COVID-19 pneumonia: a longitudinal study [e-pub ahead of print]. Radiology. https://doi.org/10.1148/radiol.2020200843, accessed April 23, 2020.

        • Martí-Climent J.M.
        • Prieto E.
        • Morán V.
        • et al.
        Effective dose estimation for oncological and neurological PET/CT procedures.
        EJNMMI Res. 2017; 7: 37
        • Lee J.C.
        • Platts D.G.
        • Huang Y.T.
        • Slaughter R.E.
        Positron emission tomography combined with computed tomography as an integral component in evaluation of primary cardiac lymphoma.
        Clin Cardiol. 2010; 33: E106-E108

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