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DOI: 10.1016/j.remnie.2021.03.005
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Available online 17 March 2021
Follow-up 18F-FDG PET/CT in an oncological asymptomatic COVID-19 patient
18F-FDG PET/CT de seguimiento en un paciente oncológico portador asintomático de COVID-19
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D.A. López-Mora
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dlopezmo@santpau.cat

Corresponding author.
, A. Fernández, J. Duch, I. Carrio
Servicio de Medicina Nuclear, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
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68-year-old man presenting with urothelial carcinoma in complete response after cystoprostatectomy and chemotherapy. An abdomine-pelvic CT scan performed in an external center showed retroperitoneal adenopathies suspicious of tumor recurrence. These finding led to a baseline 18F-FDG PET/CT. The baseline 18F-FDG PET/CT performed did not show hypermetabolic lesions suspicious of local recurrence nor lymph nodes (including retroperitoneal territories) nor metastases. However, the study showed peripheral bilateral pulmonary hipermetabolic ground-glass opacities1 predominantly in the superior lobes, suggestive of active pulmonary infectious disease (probably COVID-19 in the current pandemic context). When the baseline 18F-FDG PET/CT was performed the patient was asymptomatic and we suggested him to undergo reverse transcription–polymerase chain reaction (RT-PCR) of the nasopharyngeal exudate, but the patient did not consult. After 5 days in quarantine, the patient re-consulted due to symptoms compatible with pneumonia, being diagnosed by RT-PCR of SARS-COV-2 (Severe Acute Respiratory Syndrome Coronavirus 2, for its acronym). The patient received incomplete treatment with hydroxychloroquine and oxygenotherapy due to voluntary abandonment. Three months later, while the patient was asymptomatic, a follow-up 18F-FDG PET/CT was performed, and showed multiple liver metastases (Fig. 1-1b, red arrows) and resolution of the bilateral hypermetabolic pulmonary opacities (Fig. 2a).

Fig. 1.

68-year-old man with urothelial carcinoma in complete response after cystoprostatectomy and chemotherapy. Baseline 18F-FDG PET/CT (image 1) showed multiple peripheral bilateral pulmonary hipermetabolic ground-glass opacities predominantly in superior lobes, suggestive of active pulmonary infectious disease (image 1a; red arrows), without other hypermetabolic lesions suggestive of malignancy (Image 1-1b). The follow-up 18F-FDG PET/CT (performed 3 months after baseline PET/CT; image 2) showed resolution of the bilateral pulmonary ground-glass opacities (image 2a) and multiple hypermetabolic liver lesions suggestive of liver metastases (segment I and segment VIII; image 2b; blue arrows).

(0.25MB).

This image highlights the usefulness of 18F-FDG PET/TC in the early detection of asymptomatic patients with COVID-191 and its potential utility in the follow-up of these group of patients. To the extent of our knowledge, no cases of follow-up 18FDG-PET/CT have been reported in oncological patients with COVID-19. This image also highlights the good sensitivity of 18F-FDG PET/CT to assess evolution and possible secuelae of SARS-COV-2.2 However, 18F-FDG PET/CT is not recommended as a routine imaging modality as it is a technique with a high radiation dose and prolonged exam times, and with a possible risk of infectious diseases spreading.3

References
[1]
J. Castell.
Medicina Nuclear en la pandemia por Covid-19.
Rev Esp Med Nucl Imagen Mol, 39 (2020), pp. 138-139
[2]
Y. Deng, L. Lei, Y. Chen, W. Zhang.
The potential added value of FDG PET/CT for COVID-19 pneumonia.
Eur J Nucl Med Mol Imaging, 47 (2020), pp. 1634-1635
[3]
B. Joob, V. Wiwanitkit.
18F-FDG PET/CT and COVID-19.
Eur J Nucl Med Mol Imaging, 47 (2020), pp. 1348

Please cite this article as: López-Mora DA, Fernández A, Duch J, Carrio I. 18F-FDG PET/TC de seguimiento en un paciente oncológico portador asintomático de COVID-19. Rev Esp Med Nucl Imagen Mol. 2021. https://doi.org/10.1016/j.remn.2020.11.004

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