Incidental Findings Suggestive of COVID-19 in Asymptomatic Patients Undergoing Nuclear Medicine Procedures in a High-Prevalence Region
Incidental Findings Suggestive of COVID-19 in Asymptomatic Patients Undergoing Nuclear Medicine Procedures in a High-Prevalence Region
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DOI：
10.2967/jnumed.120.246256
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发表时间：
2020-05-01
影响因子：
9.3
通讯作者：
Giubbini, Raffaele
中科院分区：
文献类型：
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作者：
Albano, Domenico;Bertagna, Francesco;Giubbini, Raffaele
感染新型严重急性呼吸综合征冠状病毒2型(SARS-CoV-2)可能仍然没有症状，导致对相关疾病-冠状病毒病，2019年(新冠肺炎)的认识不足，并在标准临床指征下进行核成像程序中偶然发现。在这里，我们报告了我们在一个新冠肺炎患病率高且感染率动态上升的地区的经验。方法：在2020年3月16日至24日的8天期间，我们分析了在意大利布雷西亚接受F-18-FDGPET/CT或I-131SPECT/CT标准肿瘤学指征的无症状患者的混合影像表现，以寻找提示新冠肺炎的结果。确定间质性肺炎的存在、放射学特征和代谢活动，与随后的短期临床病程相关，并在病例系列中进行描述。结果：65例接受PET/CT检查的恶性肿瘤患者中，6例(9%)在CT上发现意外的间质性肺炎征象和局部F-18-FDG亲和力升高。此外，在12例接受放射性碘治疗的分化型甲状腺癌患者中，有1例在SPECT/CT上也表现为间质性肺炎。7例患者中有5例经逆转录聚合酶链式反应证实为新冠肺炎。其余2名患者没有立即进行检测，但接受了隔离和仔细监测。结论：在SARS-CoV-2广泛传播地区的无症状患者的混合成像中，偶然发现新冠肺炎可能并不少见。核医学服务机构应该做好相应的准备。
Infection with the novel severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) may remain asymptomatic, leading to underrecognition 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 F-18-FDG PET/CT or I-131 SPECT/CT for standard oncologic indications at our institution in Brescia, Italy, were analyzed for findings suggestive of COVID-19. The presence, radio logic 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 F-18-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.