1
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van Leer B, van Snick JH, Londema M, Nijsten MWN, Kasalak Ö, Slart RHJA, Glaudemans AWJM, Pillay J. [ 18F]FDG-PET/CT in mechanically ventilated critically ill patients with COVID-19 ARDS and persistent inflammation. Clin Transl Imaging 2023; 11:297-306. [PMID: 37275950 PMCID: PMC10008145 DOI: 10.1007/s40336-023-00550-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/23/2023] [Indexed: 03/14/2023]
Abstract
Purpose We report the findings of four critically ill patients who underwent an [18F]FDG-PET/CT because of persistent inflammation during the late phase of their COVID-19. Methods Four mechanically ventilated patients with COVID-19 were retrospectively discussed in a research group to evaluate the added value of [18F]FDG-PET/CT. Results Although pulmonary PET/CT findings differed, bilateral lung anomalies could explain the increased CRP and leukocytes in all patients. This underscores the limited ability of the routine laboratory to discriminate inflammation from secondary infections. Based on PET/CT findings, a secondary infection/inflammatory focus was suspected in two patients (pancreatitis and gastritis). Lymphadenopathy was present in patients with a detectable SARS-CoV-2 viral load. Muscle uptake around the hips or shoulders was observed in all patients, possibly due to the process of heterotopic ossification. Conclusion This case series illustrates the diagnostic potential of [18F]FDG-PET/CT imaging in critically ill patients with persistent COVID-19 for the identification of other causes of inflammation and demonstrates that this technique can be performed safely in mechanically ventilated critically ill patients.
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Affiliation(s)
- Bram van Leer
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Critical Care, University Medical Center Groningen, University of Groningen, TA29, PO box: 30 001, 9700 RB Groningen, The Netherlands
| | - Johannes H. van Snick
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mark Londema
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Critical Care, University Medical Center Groningen, University of Groningen, TA29, PO box: 30 001, 9700 RB Groningen, The Netherlands
| | - Maarten W. N. Nijsten
- Department of Critical Care, University Medical Center Groningen, University of Groningen, TA29, PO box: 30 001, 9700 RB Groningen, The Netherlands
| | - Ömer Kasalak
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Riemer H. J. A. Slart
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Biomedical Photonic Imaging Group, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
| | - Andor W. J. M. Glaudemans
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Janesh Pillay
- Department of Critical Care, University Medical Center Groningen, University of Groningen, TA29, PO box: 30 001, 9700 RB Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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2
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Minamimoto R. Oncology and cardiology positron emission tomography/computed tomography faced with COVID-19: A review of available literature data. Front Med (Lausanne) 2022; 9:1052921. [PMID: 36341267 PMCID: PMC9626818 DOI: 10.3389/fmed.2022.1052921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 10/07/2022] [Indexed: 09/07/2024] Open
Abstract
The COVID-19 pandemic has forced people to significantly change their lifestyles and attitudes, and has greatly burdened healthcare delivery systems worldwide. The redistribution of the medical delivery system to maintain normal medical care while responding generously to COVID-19 is a continuing challenge that weighs heavily on medical institutions. Among imaging modalities, chest X-rays and computed tomography (CT) examinations have clearly made a large contribution to treatment of COVID-19. In contrast, it is difficult to express the standpoint of nuclear medicine examinations in a straightforward manner, as the greatest emphasis in this modality has been on how necessary medical care can continue to be provided. Many clinical reports of nuclear medicine examinations related to COVID-19 have been published, and knowledge continues to accumulate. This review provides a summary of the current state of oncology and cardiology positron emission tomography (PET) examinations related to COVID-19, and includes preparation of the nuclear medicine department, trends in PET examinations, specific imaging findings on 18F-fluorodeoxyglucose (FDG) PET/CT, imaging of complications of COVID-19, PET tracers other than FDG, and the effects of vaccines on PET imaging findings.
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Affiliation(s)
- Ryogo Minamimoto
- Division of Nuclear Medicine, National Center for Global Health and Medicine, Tokyo, Japan
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3
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Tsujikawa T, Anzai M, Umeda Y, Tsuyoshi H, Kosaka N, Kimura H, Okazawa H. COVID-19 pneumonia detected by [ 18F]FDG PET/MRI: a case with negative antigen test and chest X-ray results. BJR Case Rep 2022; 7:20210131. [PMID: 35300238 PMCID: PMC8906151 DOI: 10.1259/bjrcr.20210131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/01/2021] [Accepted: 09/01/2021] [Indexed: 01/18/2023] Open
Abstract
Since the outbreak of pneumonia caused by a novel coronavirus (SARS-CoV-2) named Coronavirus disease 2019 (COVID-19) in China, researchers have reported the fluorodeoxyglucose positron emission tomography/CT (FDG PET/CT) manifestations of COVID-19 infection. We present a 37-year-old female with early-stage cervical cancer and fever without a focus who had negative SARS-CoV-2 antigen test and chest X-ray results. FDG PET/MRI performed for preoperative evaluation incidentally detected pneumonia showing high FDG uptake and diffusion-weighted imaging signals in right lung base. She retested positive for SARS-CoV-2 and was diagnosed as having COVID-19 pneumonia. Whole-body PET/MRI can provide multi functional images and could be useful for evaluating the pathophysiology of COVID-19.
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Affiliation(s)
- Tetsuya Tsujikawa
- Biomedical
Imaging Research Center, University of Fukui,
Fukui, Japan
| | - Masaki Anzai
- Third
Department of Internal Medicine, Faculty of Medical Sciences, University of
Fukui, Fukui,
Japan
| | - Yukihiro Umeda
- Third
Department of Internal Medicine, Faculty of Medical Sciences, University of
Fukui, Fukui,
Japan
| | - Hideaki Tsuyoshi
- Department
of Obstetrics and Gynecology, Faculty of Medical Sciences, University of
Fukui, Fukui,
Japan
| | - Nobuyuki Kosaka
- Department
of Radiology, Faculty of Medical Sciences, University of
Fukui, Fukui,
Japan
| | - Hirohiko Kimura
- Department
of Radiology, Faculty of Medical Sciences, University of
Fukui, Fukui,
Japan
| | - Hidehiko Okazawa
- Biomedical
Imaging Research Center, University of Fukui,
Fukui, Japan
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4
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Albano D, Bertagna F, Alongi P, Baldari S, Baldoncini A, Bartolomei M, Boccaletto F, Boero M, Borsatti E, Bruno A, Burroni L, Capoccetti F, Castellani M, Cervino AR, Chierichetti F, Ciarmiello A, Corso A, Cuocolo A, De Rimini ML, Deandreis D, Dottorini ME, Esposito F, Farsad M, Gasparini M, Grana CM, Gregianin M, Guerra L, Loreti F, Lupi A, Martino G, Milan E, Modoni S, Morbelli S, Muni A, Nicolai E, Palumbo B, Papa S, Papaleo A, Pellerito R, Poti C, Romano P, Rossetti C, Rossini P, Rubini G, Ruffini L, Sacchetti G, Savelli G, Schiavariello S, Sciagrà R, Sciuto R, Seregni E, Sestini S, Sicolo M, Spanu A, Storto G, Balducci MT, Trifirò G, Versari A, Vignati A, Volterrani D, Calcagni ML, Marzola MC, Garufo A, Evangelista L, Maroldi R, Schillaci O, Giubbini R. Prevalence of interstitial pneumonia suggestive of COVID-19 at 18F-FDG PET/CT in oncological asymptomatic patients in a high prevalence country during pandemic period: a national multi-centric retrospective study. Eur J Nucl Med Mol Imaging 2021; 48:2871-2882. [PMID: 33560453 PMCID: PMC7871520 DOI: 10.1007/s00259-021-05219-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/24/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To assess the presence and pattern of incidental interstitial lung alterations suspicious of COVID-19 on fluorine-18-fluorodeoxyglucose positron emission tomography (PET)/computed tomography (CT) ([18F]FDG PET/CT) in asymptomatic oncological patients during the period of active COVID-19 in a country with high prevalence of the virus. METHODS This is a multi-center retrospective observational study involving 59 Italian centers. We retrospectively reviewed the prevalence of interstitial pneumonia detected during the COVID period (between March 16 and 27, 2020) and compared to a pre-COVID period (January-February 2020) and a control time (in 2019). The diagnosis of interstitial pneumonia was done considering lung alterations of CT of PET. RESULTS Overall, [18F]FDG PET/CT was performed on 4008 patients in the COVID period, 19,267 in the pre-COVID period, and 5513 in the control period. The rate of interstitial pneumonia suspicious for COVID-19 was significantly higher during the COVID period (7.1%) compared with that found in the pre-COVID (5.35%) and control periods (5.15%) (p < 0.001). Instead, no significant difference among pre-COVID and control periods was present. The prevalence of interstitial pneumonia detected at PET/CT was directly associated with geographic virus diffusion, with the higher rate in Northern Italy. Among 284 interstitial pneumonia detected during COVID period, 169 (59%) were FDG-avid (average SUVmax of 4.1). CONCLUSIONS A significant increase of interstitial pneumonia incidentally detected with [18F]FDG PET/CT has been demonstrated during the COVID-19 pandemic. A majority of interstitial pneumonia were FDG-avid. Our results underlined the importance of paying attention to incidental CT findings of pneumonia detected at PET/CT, and these reports might help to recognize early COVID-19 cases guiding the subsequent management.
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Affiliation(s)
- Domenico Albano
- Nuclear Medicine, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy.
| | - Francesco Bertagna
- Nuclear Medicine, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy
| | - Pierpaolo Alongi
- Unit of Nuclear Medicine, Fondazione Istituto G.Giglio, 90015, Cefalù, Italy
| | - Sergio Baldari
- Department of Biomedical and Dental Sciences and of Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, 98125, Messina, Italy
| | | | - Mirco Bartolomei
- Nuclear Medicine Department, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | | | - Michele Boero
- Nuclear Medicine Unit, ARNAS G. Brotzu, Cagliari, Italy
| | | | - Andrea Bruno
- Department of Nuclear Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Luca Burroni
- Department of Nuclear Medicine, "Ospedali Riuniti di Torrette" Hospital, Ancona, Italy
| | - Francesca Capoccetti
- Service Department Macerata Hospital, ASUR Marche AV3, Nuclear Medicine Unit, Macerata, Italy
| | - Massimo Castellani
- Nuclear Medicine Department, Fondazione IRCCS Cà Grande Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Rita Cervino
- Nuclear Medicine Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | | | | | - Angelo Corso
- Department of Nuclear Medicine, Sant'Anna Hospital, Como, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | | | - Desiree' Deandreis
- Division of Nuclear Medicine, Department of Medical Sciences, University of Turin, AOU Città della Salute e della Scienza, 10126, Turin, Italy
| | - Massimo Eugenio Dottorini
- Department of Diagnostic Imaging, Nuclear Medicine Unit, Ospedale "S. Maria della Misericordia", Perugia, Italy
| | | | - Mohsen Farsad
- Nuclear Medicine, Central Hospital Bolzano, Bolzano, Italy
| | - Massimo Gasparini
- Department of Nuclear Medicine, IRCCS MultiMedica Sesto San Giovanni, Milan, Italy
| | - Chiara Maria Grana
- Division of Nuclear Medicine, European Institute of Oncology, IRCCS, Milan, Italy
| | - Michele Gregianin
- Nuclear Medicine Unit, Veneto Institute of Oncology IOV-IRCCS, Castelfranco Veneto, Italy
| | - Luca Guerra
- Nuclear Medicine, University of Milan Bicocca and ASST Ospedale San Gerardo, Monza, Italy
| | - Fabio Loreti
- Nuclear Medicine Unit, S. Maria Hospital, Terni, Italy
| | - Andrea Lupi
- Division of Nuclear Medicine, Ospedale S. Bortolo, Vicenza, Italy
| | - Gianluigi Martino
- Unit of Nuclear Medicine, Department of Radiology and Clinical Radiotherapy, SS Annunziata Hospital, Chieti, Italy
| | - Elisa Milan
- Nuclear Medicine Department, Treviso Hospital, Treviso, Italy
| | - Sergio Modoni
- Nuclear Medicine Department, University Hospital Ospedali Riuniti, Foggia, Italy
| | - Silvia Morbelli
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Science (DISSAL), University of Genoa, Genoa, Italy
| | - Alfredo Muni
- Nuclear Medicine Department, Azienda Ospedaliera S.S. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | | | - Barbara Palumbo
- Department of Diagnostic Imaging, Nuclear Medicine Unit, Ospedale "S. Maria della Misericordia", Perugia, Italy
- Section of Nuclear Medicine and Health Physics, Department of Medicine and Surgery-University of Perugia, Perugia, Italy
| | - Sergio Papa
- Unit of Diagnostic Imaging and Stereotactic Radiosurgery, CDI Centro Diagnostico Italiano,, Via Saint Bon 20, 20147, Milan, Italy
| | - Alberto Papaleo
- Nuclear Medicine Department, S. Croce e Carle Hospital Cuneo, Cuneo, Italy
| | | | - Carlo Poti
- Unit of Nuclear Medicine, Aosta Regional Hospital, Aosta, Italy
| | - Pasquale Romano
- Department of Nuclear Medicine, Studio Radiologico Guidonia, Guidonia, Italy
| | - Claudio Rossetti
- Nuclear Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Pierluigi Rossini
- Nuclear Medicine, Azienda Socio Sanitaria Territoriale di Mantova. Ospedale C. Poma, Mantova, Italy
| | - Giuseppe Rubini
- Nuclear Medicine Unit, Department of Interdisciplinary Medicine, AOU Policlinico, University of Bari, Bari, Italy
| | - Livia Ruffini
- Nuclear Medicine Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | - Giordano Savelli
- Nuclear Medicine Department, Fondazione Poliambulanza, Brescia, Italy
| | | | - Roberto Sciagrà
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Rosa Sciuto
- Nuclear Medicine Unit, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Ettore Seregni
- Division of Nuclear Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stelvio Sestini
- Unit of Nuclear Medicine, Department of Diagnostic Imaging, N.O.P. - S. Stefano, U.S.L. Toscana Centro, Prato, Italy
| | - Michele Sicolo
- Nuclear Medicine Unit, Dell'Angelo Hospital, Mestre-Venezia, Italy
| | - Angela Spanu
- Nuclear Medicine Unit, Department of Medical, Surgical and Experimental sciences, University of Sassari, Sassari, Italy
| | - Giovanni Storto
- Nuclear Medicine Department, IRCCS CROB, Referral Cancer Center of Basilicata, 85028, Rionero in Vulture, Italy
| | | | - Giuseppe Trifirò
- Nuclear Medicine Department, ICS Maugeri SpA SB-IRCCS, Pavia, Italy
| | - Annibale Versari
- Nuclear Medicine Unit, Azienda AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alberto Vignati
- Nuclear Medicine Department, ASST Ovest Milanese, Legnano, Italy
| | - Duccio Volterrani
- Regional Center of Nuclear Medicine, University Hospital of Pisa, Pisa, Italy
| | - Maria Lucia Calcagni
- Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore, & UOC di Medicina Nucleare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Maria Cristina Marzola
- Department of Nuclear Medicine PET/CT Centre, S. Maria della Misericordia Hospital, 45100, Rovigo, Italy
| | - Antonio Garufo
- Nuclear Medicine Department, ASP Agrigento, Agrigento, Italy
| | - Laura Evangelista
- Nuclear Medicine Unit, Department of Medicine-DIMED, University of Padova, 35128, Padova, Italy
| | - Roberto Maroldi
- Department of Radiology, University of Brescia, ASST Spedali Civili Brescia, Brescia, Italy
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, Tor Vergata University Hospital, Rome, Italy
| | - Raffaele Giubbini
- Nuclear Medicine, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy
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5
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Wakfie-Corieh CG, Ferrando-Castagnetto F, Blanes Garcia AM, Garcia-Esquinas MG, Ortega Candil A, Rodriguez Rey C, Cabrera Martin MN, Delgado Cano A, Carreras Delgado JL. Incidental findings suggestive of COVID-19 pneumonia in oncological patients undergoing 18F-FDG PET/CT studies: association between metabolic and structural lung changes. J Nucl Med 2021; 63:274-279. [PMID: 34088776 PMCID: PMC8805775 DOI: 10.2967/jnumed.121.261915] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/05/2021] [Indexed: 11/16/2022] Open
Abstract
Although the novel coronavirus disease 2019 (COVID-19) can present as non-specific clinical forms, subclinical cases represent an important route of transmission and a significant source of mortality, mainly in high-risk subpopulations such as cancer patients. A deeper knowledge about the shift in cellular metabolism of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected cells could provide new insights about its pathogenic and host response and help to diagnose pulmonary involvement. We explored the association between metabolic and structural changes of lung parenchyma in asymptomatic cancer patients with suspected COVID-19 pneumonia, as a potential added diagnostic value of fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography-computed tomography (PET/CT) scans in this subpopulation. Methods: Within the period of February 19 and May 29, 2020 18F-FDG PET/CT studies were reviewed to identify those cancer patients with suggestive incidental findings of COVID-19 pneumonia. PET studies were interpreted through qualitative (visual) and semiquantitative analysis (measurement of maximum standardized uptake value, SUVmax) evaluating lung findings. Several characteristic signs of COVID-19 pneumonia on computed tomography (CT) were described as COVID-19 Reporting and Data System (CO-RADS) categories (1-6). After comparing SUVmax values of pulmonary infiltrates among different CO-RADS categories, we explored the best potential cut-off values of pulmonary SUVmax against CO-RADS categories as "gold standard" result to discard the diagnosis of COVID-19 pneumonia. Results: CT signs classified as CO-RADS category 5 or 6 were found in 16/41 (39%) oncological patients derived to multimodal PET/CT imaging. SUVmax was higher in patients with CO-RADS 5 and 6 vs. 4 (6.17±0.82 vs. 3.78±0.50, P = 0.04) and vs. 2 and 3 categories (3.59±0.41, P = 0.01). A specificity of 93.8% (IC 95%: 71.7-99.7%) and an accuracy of 92.9% were obtained when combining a CO-RADS score 5-6 with a SUVmax of 2.45 in pulmonary infiltrates. Conclusion: In asymptomatic cancer patients, the metabolic activity in lung infiltrates is closely associated with several combined tomographic changes characteristic of COVID-19 pneumonia. Multimodal 18F-FDG PET/CT imaging could provide additional information during early diagnosis in selected predisposed patients during pandemic. The prognostic implications of simultaneous radiological and molecular findings in cancer and other high-risk subpopulations for COVID-19 pneumonia deserve further evaluation in prospective researches.
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6
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Ramos CD, Fernandes AP, Souza SPM, Fujiwara M, Tobar N, Dertkigil SSJ, Takahashi MES, Gonçales ESL, Trabasso P, Zantut-Wittmann DE. Simultaneous Imaging of Lung Perfusion and Glucose Metabolism in COVID-19 Pneumonia. Am J Respir Crit Care Med 2021; 203:1186-1187. [PMID: 33636089 PMCID: PMC8314896 DOI: 10.1164/rccm.202007-2944im] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Eduardo S L Gonçales
- Gleb Wataghin Institute of Physics, University of Campinas, Campinas, São Paulo, Brazil
| | - Plinio Trabasso
- Gleb Wataghin Institute of Physics, University of Campinas, Campinas, São Paulo, Brazil
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7
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Pallares R, Abergel RJ. Diagnostic, Prognostic, and Therapeutic Use of Radiopharmaceuticals in the Context of SARS-CoV-2. ACS Pharmacol Transl Sci 2021; 4:1-7. [PMID: 33615159 PMCID: PMC7839413 DOI: 10.1021/acsptsci.0c00186] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Indexed: 01/18/2023]
Abstract
The coronavirus disease 2019 (COVID-19) outbreak has devastated the healthcare systems and economies of over 200 countries in just a few months. The etiological agent of COVID-19, SARS-CoV-2, is a highly contagious virus that can be transmitted by asymptomatic and symptomatic carriers alike. While in vitro testing techniques have allowed for population-wide screening, prognostic tools are required to assess the disease severity and therapeutic response, contributing to improve the patient clinical outcomes. Moreover, no specific antiviral against COVID-19 exists at the time of publication, severely limiting treatment against the infection. Hence, there is an urgent clinical need for innovative therapeutic strategies that may contribute to manage the COVID-19 outbreak and prevent future pandemics. Herein, we critically examine recent diagnostic, prognostic, and therapeutic advancements for COVID-19 in the field of radiopharmaceuticals. First, we summarize the gold standard techniques used to diagnose COVID-19, including in vitro assays and imaging techniques, and then discuss how radionuclide-based nuclear imaging provides complementary information for prognosis and treatment management of infected patients. Second, we introduce new emerging types of radiotherapies that employ radioimmunoconjugates, which have shown selective cytotoxic response in oncological studies, and critically analyze how these compounds could be used as therapeutic agents against SARS-CoV-2. Finally, this Perspective further discusses the emerging applications of radionuclides to study the behavior of pulmonary SARS-CoV-2 aerosol particles.
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Affiliation(s)
- Roger
M. Pallares
- Chemical
Sciences Division, Lawrence Berkeley National
Laboratory, Berkeley, California 94720, United States
| | - Rebecca J. Abergel
- Chemical
Sciences Division, Lawrence Berkeley National
Laboratory, Berkeley, California 94720, United States
- Department
of Nuclear Engineering, University of California, Berkeley, California 94720, United States
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8
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Casali M, Lauri C, Altini C, Bertagna F, Cassarino G, Cistaro A, Erba AP, Ferrari C, Mainolfi CG, Palucci A, Prandini N, Baldari S, Bartoli F, Bartolomei M, D’Antonio A, Dondi F, Gandolfo P, Giordano A, Laudicella R, Massollo M, Nieri A, Piccardo A, Vendramin L, Muratore F, Lavelli V, Albano D, Burroni L, Cuocolo A, Evangelista L, Lazzeri E, Quartuccio N, Rossi B, Rubini G, Sollini M, Versari A, Signore A. State of the art of 18F-FDG PET/CT application in inflammation and infection: a guide for image acquisition and interpretation. Clin Transl Imaging 2021; 9:299-339. [PMID: 34277510 PMCID: PMC8271312 DOI: 10.1007/s40336-021-00445-w] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/19/2021] [Indexed: 02/06/2023]
Abstract
AIM The diagnosis, severity and extent of a sterile inflammation or a septic infection could be challenging since there is not one single test able to achieve an accurate diagnosis. The clinical use of 18F-fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) imaging in the assessment of inflammation and infection is increasing worldwide. The purpose of this paper is to achieve an Italian consensus document on [18F]FDG PET/CT or PET/MRI in inflammatory and infectious diseases, such as osteomyelitis (OM), prosthetic joint infections (PJI), infective endocarditis (IE), prosthetic valve endocarditis (PVE), cardiac implantable electronic device infections (CIEDI), systemic and cardiac sarcoidosis (SS/CS), diabetic foot (DF), fungal infections (FI), tuberculosis (TBC), fever and inflammation of unknown origin (FUO/IUO), pediatric infections (PI), inflammatory bowel diseases (IBD), spine infections (SI), vascular graft infections (VGI), large vessel vasculitis (LVV), retroperitoneal fibrosis (RF) and COVID-19 infections. METHODS In September 2020, the inflammatory and infectious diseases focus group (IIFG) of the Italian Association of Nuclear Medicine (AIMN) proposed to realize a procedural paper about the clinical applications of [18F]FDG PET/CT or PET/MRI in inflammatory and infectious diseases. The project was carried out thanks to the collaboration of 13 Italian nuclear medicine centers, with a consolidate experience in this field. With the endorsement of AIMN, IIFG contacted each center, and the pediatric diseases focus group (PDFC). IIFG provided for each team involved, a draft with essential information regarding the execution of [18F]FDG PET/CT or PET/MRI scan (i.e., indications, patient preparation, standard or specific acquisition modalities, interpretation criteria, reporting methods, pitfalls and artifacts), by limiting the literature research to the last 20 years. Moreover, some clinical cases were required from each center, to underline the teaching points. Time for the collection of each report was from October to December 2020. RESULTS Overall, we summarized 291 scientific papers and guidelines published between 1998 and 2021. Papers were divided in several sub-topics and summarized in the following paragraphs: clinical indications, image interpretation criteria, future perspectivess and new trends (for each single disease), while patient preparation, image acquisition, possible pitfalls and reporting modalities were described afterwards. Moreover, a specific section was dedicated to pediatric and PET/MRI indications. A collection of images was described for each indication. CONCLUSIONS Currently, [18F]FDG PET/CT in oncology is globally accepted and standardized in main diagnostic algorithms for neoplasms. In recent years, the ever-closer collaboration among different European associations has tried to overcome the absence of a standardization also in the field of inflammation and infections. The collaboration of several nuclear medicine centers with a long experience in this field, as well as among different AIMN focus groups represents a further attempt in this direction. We hope that this document will be the basis for a "common nuclear physicians' language" throughout all the country. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40336-021-00445-w.
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Affiliation(s)
- Massimiliano Casali
- Nuclear Medicine Unit, Azienda Unità Sanitaria Locale IRCCS, Reggio Emilia, Italy
| | - Chiara Lauri
- grid.7841.aNuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Corinna Altini
- grid.7644.10000 0001 0120 3326Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Francesco Bertagna
- grid.412725.7Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Gianluca Cassarino
- grid.5608.b0000 0004 1757 3470Nuclear Medicine Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | | | - Anna Paola Erba
- grid.5395.a0000 0004 1757 3729Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Cristina Ferrari
- grid.7644.10000 0001 0120 3326Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Ciro Gabriele Mainolfi
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy
| | - Andrea Palucci
- grid.415845.9Department of Nuclear Medicine, “Ospedali Riuniti di Torrette” Hospital, Ancona, Italy
| | - Napoleone Prandini
- grid.418324.80000 0004 1781 8749Nuclear Medicine Unit, Department of Diagnostic Imaging, Centro Diagnostico Italiano, Milan, Italy
| | - Sergio Baldari
- grid.10438.3e0000 0001 2178 8421Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and of Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Francesco Bartoli
- grid.5395.a0000 0004 1757 3729Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Mirco Bartolomei
- grid.416315.4Nuclear Medicine Unit, Oncological Medical and Specialists Department, University Hospital of Ferrara, Ferrara, Italy
| | - Adriana D’Antonio
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy
| | - Francesco Dondi
- grid.412725.7Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Patrizia Gandolfo
- grid.418324.80000 0004 1781 8749Nuclear Medicine Unit, Department of Diagnostic Imaging, Centro Diagnostico Italiano, Milan, Italy
| | - Alessia Giordano
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy
| | - Riccardo Laudicella
- grid.10438.3e0000 0001 2178 8421Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and of Morpho-Functional Imaging, University of Messina, Messina, Italy
| | | | - Alberto Nieri
- grid.416315.4Nuclear Medicine Unit, Oncological Medical and Specialists Department, University Hospital of Ferrara, Ferrara, Italy
| | | | - Laura Vendramin
- grid.5608.b0000 0004 1757 3470Nuclear Medicine Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Francesco Muratore
- Rheumatology Unit, Azienda Unità Sanitaria Locale IRCCS, Reggio Emilia, Italy
| | - Valentina Lavelli
- grid.7644.10000 0001 0120 3326Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Domenico Albano
- grid.412725.7Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Luca Burroni
- grid.415845.9Department of Nuclear Medicine, “Ospedali Riuniti di Torrette” Hospital, Ancona, Italy
| | - Alberto Cuocolo
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy
| | - Laura Evangelista
- grid.5608.b0000 0004 1757 3470Nuclear Medicine Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Elena Lazzeri
- grid.5395.a0000 0004 1757 3729Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Natale Quartuccio
- grid.419995.9Nuclear Medicine Unit, A.R.N.A.S. Civico di Cristina and Benfratelli Hospitals, Palermo, Italy
| | - Brunella Rossi
- Nuclear Medicine Unit, Department of Services, ASUR MARCHE-AV5, Ascoli Piceno, Italy
| | - Giuseppe Rubini
- grid.7644.10000 0001 0120 3326Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Martina Sollini
- grid.417728.f0000 0004 1756 8807Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Annibale Versari
- Nuclear Medicine Unit, Azienda Unità Sanitaria Locale IRCCS, Reggio Emilia, Italy
| | - Alberto Signore
- grid.7841.aNuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, “Sapienza” University of Rome, Rome, Italy
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9
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Hempel L, Piehler A, Pfaffl MW, Molnar J, Kirchner B, Robert S, Veloso J, Gandorfer B, Trepotec Z, Mederle S, Keim S, Milani V, Ebner F, Schweneker K, Fleischmann B, Kleespies A, Scheiber J, Hempel D, Zehn D. SARS-CoV-2 infections in cancer outpatients-Most infected patients are asymptomatic carriers without impact on chemotherapy. Cancer Med 2020; 9:8020-8028. [PMID: 33022856 PMCID: PMC7643635 DOI: 10.1002/cam4.3435] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/09/2020] [Accepted: 08/12/2020] [Indexed: 12/13/2022] Open
Abstract
Oncologic patients are regarded as the population most at risk of developing a severe course of COVID‐19 due to the fact that malignant diseases and chemotherapy often weaken the immune system. In the face of the ongoing SARS‐CoV‐2 pandemic, how particular patients deal with this infection remains an important question. In the period between the 15 and 26 April 2020, a total of 1227 patients were tested in one of seven oncologic outpatient clinics for SARS‐CoV‐2, regardless of symptoms, employing RT‐qPCR. Of 1227 patients, 78 (6.4%) were tested positive of SARS‐CoV‐2. Only one of the patients who tested positive developed a severe form of COVID‐19 with pneumonia (CURB‐65 score of 2), and two patients showed mild symptoms. Fourteen of 75 asymptomatic but positively tested patients received chemotherapy or chemo‐immunotherapy according to their regular therapy algorithm (±4 weeks of SARS‐CoV‐2 test), and 48 of 78 (61.5%) positive‐tested patients received glucocorticoids as co‐medication. None of the asymptomatic infected patients showed unexpected complications due to the SARS‐CoV‐2 infection during the cancer treatment. These data clearly contrast the view that patients with an oncologic disease are particularly vulnerable to SARS‐CoV‐2 and suggest that compromising therapies could be continued or started despite the ongoing pandemic. Moreover the relatively low appearance of symptoms due to COVID‐19 among patients on chemotherapy and other immunosuppressive co‐medication like glucocorticoids indicate that suppressing the response capacity of the immune system reduces disease severity.
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Affiliation(s)
| | | | - Michael W Pfaffl
- Division of Animal Physiology and Immunology, School of Life Sciences Weihenstephan, Technical University of Munich, Munich, Germany
| | | | - Benedikt Kirchner
- Division of Animal Physiology and Immunology, School of Life Sciences Weihenstephan, Technical University of Munich, Munich, Germany
| | - Sebastian Robert
- Fraunhofer Institute of Optronics, System Technologies, and Image Exploitation IOSB, Karlsruhe, Germany
| | - Julia Veloso
- Fraunhofer Institute of Optronics, System Technologies, and Image Exploitation IOSB, Karlsruhe, Germany
| | | | | | | | - Sabine Keim
- Department of Obstetrics, Helios Clinic Pasing, München, Germany
| | | | | | | | | | | | | | | | - Dietmar Zehn
- Division of Animal Physiology and Immunology, School of Life Sciences Weihenstephan, Technical University of Munich, Munich, Germany
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10
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Accidental diagnosis of COVID-19 pneumonia after 18F FDG PET/CT: a case series. Clin Transl Imaging 2020; 8:393-400. [PMID: 32989417 PMCID: PMC7512221 DOI: 10.1007/s40336-020-00388-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/11/2020] [Indexed: 12/15/2022]
Abstract
Purpose The aim of this case series is to illustrate possible [18F]-FDG uptake patterns associated to COVID-19. Methods Retrospective assessment of all Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scans performed for any clinical / oncological reason from 1st April 2020 to 30th April 2020. Results of PCR testing for SARS-CoV-2 were retrieved for all patients with lung consolidations and/or peripheral ground glass opacities characterized by increased metabolism to evaluate any possible association with the viral infection. Results Seven (4%) out of 172 FDG-PET scans were included. Six out of seven patients (85%) had positive RT-PCR for SARS-CoV-2, while one patient (15%) had possible (not PCR confirmed) COVID-19 pneumonia. Conclusion Suspicious accidental COVID-19 findings in Nuclear Medicine Department need to be reported and appropriately evaluated to implement proper supportive treatment and infection control measures.
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