Metabolic characterization of structural lung changes in patients with findings suggestive of incidental COVID-19 pneumonia on F-FDG PET/CT. Pathophysiological insights from multimodal images obtained during the pandemic.

Publication date: Jul 14, 2023

To evaluate the metabolic uptake of different tomographic signs observed in patients with incidental structural findings suggestive of COVID-19 pneumonia through F-FDG PET/CT. We retrospectively analyzed 596 PET/CT studies performed from February 21, 2020 to April 17, 2020. After excluding 37 scans (non-F-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 F-FDG. Forty-three patients with F-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). In those patients referred for standard oncologic and non-oncologic indications (43/559; 7. 7%) during pandemic, imaging with F-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.

Concepts Keywords
April (18)F-FDG
Male COVID-19
Pneumonia PET/CT
Suvmax SARS-CoV-2


Type Source Name
disease MESH COVID-19
disease MESH pneumonia
disease MESH crazy paving pattern
drug DRUGBANK Saquinavir

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