Abstract
PurposeTo 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.MethodsThis 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.ResultsOverall, [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).ConclusionsA 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.
Highlights
An aggressive acute respiratory disease caused by a novel coronavirus of zoonotic origin, called COVID-19, occurred during December 2019 in Wuhan, China, and spread everywhere becoming a pandemic
A significant increase of interstitial pneumonia incidentally detected with [18F]FDG positron emission tomography (PET)/computed tomography (CT) has been demonstrated during the COVID-19 pandemic
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
Summary
An aggressive acute respiratory disease caused by a novel coronavirus of zoonotic origin, called COVID-19, occurred during December 2019 in Wuhan, China, and spread everywhere becoming a pandemic. Especially Northern Italy, was hit by this infection with the maximum incidence during March [1, 2]. COVID-19 may present with no specific signs and symptoms like fever, dyspnea, and cough, but in most cases, the patients may be asymptomatic. This scenario is the most dangerous because they can be potential sources of infection for a whole population. The exact incidence of asymptomatic patients remains unclear and yet under debate. It is well known that often clinical symptoms appear when the infection is in the peak phase
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