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Vol. 42. Issue 6.
Pages 380-387 (November - December 2023)
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Vol. 42. Issue 6.
Pages 380-387 (November - December 2023)
Original Article
Metabolic characterization of structural lung changes in patients with findings suggestive of incidental COVID-19 pneumonia on 18F-FDG PET/CT. Pathophysiological insights from multimodal images obtained during the pandemic
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C.G. Wakfie-Corieha,b,
Corresponding author
cristinagwc@gmail.com

Corresponding author.
, F. Ferrando-Castagnettoc, M. García-Esquinasb,d, M.N. Cabrera-Martína,b, C. Rodríguez Reya,b, A. Ortega Candila,b, R.M. Couto Caroa,b, J.L. Carreras Delgadoa,b
a Department of Nuclear Medicine, Hospital Clínico San Carlos, Madrid, Spain
b Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
c Department of Cardiology, Cardiovascular University Center, Hospital de Clínicas Dr. Manuel Quintela, Montevideo, Uruguay
d Department of Radiology, Hospital Clínico San Carlos, Madrid, Spain
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Tables (4)
Table 1. Characterization of study population. Demographic variables and PET/CT indications in patients with parenchymal lung findings suggestive of COVID-19 pneumonia (n=43).
Table 2. Univariate association of FDG uptake with individual structural findings. Data of parenchymal SUVmax measured in patients with different lung CT changes. Results are presented in relation with CO-RADS groups (scores: 5-6 vs. 2-4) or the presence of each structural change (yes/no). Each individual CT finding is expressed as mean+SD or median [IQR].
Table 3. CO-RADS categories with CT findings in each of them.
Table 4. Results of the multivariate analysis. Selected multimodal imaging data was included as independent variables to predict the structural diagnosis of COVID-19 pneumonia.
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Abstract
Purpose

To evaluate the metabolic uptake of different tomographic signs observed in patients with incidental structural findings suggestive of COVID-19 pneumonia through 18F-FDG PET/CT.

Materials and Methods

: We retrospectively analyzed 596 PET/CT studies performed from February 21, 2020 to April 17, 2020. After excluding 37 scans (non-18F-FDG PET tracers and brain studies), we analyzed the metabolic activity of several structural changes integrated in the CO-RADS score using the SUVmax of multimodal studies with 18F-FDG.

Results

Forty-three patients with 18F-FDG PET/CT findings suggestive of COVID-19 pneumonia were included (mean age: 68±12.3 years, 22 male). SUVmax values were higher in patients with CO-RADS categories 5−6 than in those with lower CO-RADS categories (6.1±3.0 vs. 3.6±2.1, p=0.004). In patients with CO-RADS 5−6, ground-glass opacities, bilaterality and consolidations exhibited higher SUVmax values (p-values of 0.01, 0.02 and 0.01, respectively). Patchy distribution and crazy paving pattern were also associated with higher SUVmax (p-values of 0.002 and 0.01). After multivariate analysis, SUVmax was significantly associated with a positive structural diagnosis of COVID-19 pneumonia (odds ratio=0.63, 95% confidence interval=0.41−0.90; p=0.02). The ROC curve of the regression model intended to confirm or rule out the structural diagnosis of COVID-19 pneumonia showed an AUC of 0.77 (standard error=0.072, p=0.003).

Conclusions

In those patients referred for standard oncologic and non-oncologic indications (43/559; 7.7%) during pandemic, imaging with 18F-FDG PET/CT is a useful tool during incidental detection of COVID-19 pneumonia. Several CT findings characteristic of COVID-19 pneumonia, specifically those included in diagnostic CO-RADS scores (5−6), were associated with higher SUVmax values.

Keywords:
18F-FDG
PET/CT
COVID-19
SARS-CoV-2
CO-RADS

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