Incidental Findings Suggestive of COVID 19 in Asymptomatic Patients Undergoing Nuclear Medicine Procedures in a High Prevalence Region
Infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) may remain asymptomatic, leading to under recognition of the related disease, coronavirus disease, 2019 (COVID 19) and to incidental findings in nuclear imaging procedures performed for standard clinical indications. Here, we report about our local experience in a region with high COVID 19 prevalence and dynamically increasing infection rates. Methods: Within the 8 d period of March 16 24, 2020, hybrid imaging studies of asymptomatic patients who underwent 18F FDG PET/CT or 131I SPECT/CT for standard oncologic indications at our institution in Brescia, Italy, were analyzed for findings suggestive of COVID 19. The presence, radiologic features, and metabolic activity of interstitial pneumonia were identified, correlated with the subsequent short term clinical course, and described in a case series. Results: Six of 65 patients (9% who underwent PET/CT for various malignancies showed unexpected signs of interstitial pneumonia on CT and elevated regional 18F FDG avidity. Additionally, 1 of 12 patients who received radioiodine for differentiated thyroid carcinoma also showed interstitial pneumonia on SPECT/CT. Five of 7 patients had subsequent proof of COVID 19 by reverse transcriptase polymerase chain reaction. The remaining 2 patients were not tested immediately but underwent quarantine and careful monitoring. Conclusion: Incidental findings suggestive of COVID 19 may not be infrequent in hybrid imaging of asymptomatic patients in regions with an expansive spread of SARS CoV 2. Nuclear medicine services should prepare accordingly.
The Journal of Nuclear Medicine