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Abstract
The aim of this study was to assess the temporal evolution of pulmonary 18F-FDG uptake in patients with coronavirus disease 2019 (COVID-19) and post-COVID-19 lung disease (PCLD). Methods: Using our hospital's clinical electronic records, we retrospectively identified 23 acute COVID-19, 18 PCLD, and 9 completely recovered 18F-FDG PET/CT patients during the 2 peaks of the U.K. pandemic. Pulmonary 18F-FDG uptake was measured as a lung target-to-background ratio (TBRlung = SUVmax/SUVmin) and compared with temporal stage. Results: In acute COVID-19, less than 3 wk after infection, TBRlung was strongly correlated with time after infection (rs = 0.81, P < 0.001) and was significantly higher in the late stage than in the early stage (P = 0.001). In PCLD, TBRlung was lower in patients treated with high-dose steroids (P = 0.003) and in asymptomatic patients (P < 0.001). Conclusion: Pulmonary 18F-FDG uptake in COVID-19 increases with time after infection. In PCLD, pulmonary 18F-FDG uptake rises despite viral clearance, suggesting ongoing inflammation. There was lower pulmonary 18F-FDG uptake in PCLD patients treated with steroids.
Highlights
2020 there was a rapid spread of coronavirus disease 2019 (COVID-19), which may result in viral pneumonitis and acute respiratory distress syndrome [1]
Of the 3,112 18F-FDG PET/CT studies screened, 50 met the criteria for study entry, including 18 patients referred for 18F-FDG PET/CT for investigation of post–COVID-19 lung disease (PCLD)
18F-FDG uptake in COVID-19 patients increases with time after infection and correlates with severity
Summary
2020 there was a rapid spread of coronavirus disease 2019 (COVID-19), which may result in viral pneumonitis and acute respiratory distress syndrome [1]. The median time from symptom onset to intensive care admission was 10 d, only 5% of patients were admitted [1]. This is when antiviral responses are at a peak, suggesting that pneumonitis is a consequence of adaptive immunity [2]. 18F-FDG PET/CT has no role in the management of patients with COVID-19 [4], and there has been little investigation into the quantification and evolution of 18F-FDG uptake in COVID-19 (Supplemental Table 1; supplemental materials are available at http://jnm.snmjournals.org). Given the growing role of 18F-FDG PET/CT in interstitial lung diseases, the primary aim of this preliminary study was to assess the temporal evolution of 18F-FDG uptake in COVID-19 and to correlate this evolution with clinical progression and recovery. A secondary aim was to investigate whether steroids could alter this evolution
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