Abnormal F-18-fluoro-deoxy-glucose (FDG) accumulation in post-healing Coronavirus disease 2019 (Covid-19) pneumonia lesions

全文

(1)Japanese Archive of cases conference of clinical nuclear medicine 02, 2020. P. 15. https://doi.org/10.32291/nmj.2.0_15. Image in keeping in mind. Abnormal F-18-fluoro-deoxy-glucose (FDG) accumulation in post-healing Coronavirus disease 2019 (Covid-19) pneumonia lesions Japanese Archive of cases conference of clinical nuclear medicine, 2020 P.10-19 Received: December 01, 2020, Accepted: December 09, 2020. Department of Nuclear Medicine, Graduate School of Medicine, Osaka City University Joji Kawabe M.D.,Ph.D. Atsushi Yoshida M.D., Ph.D. Shigeaki Higashiyama M.D.,Ph.D. Corresponding author Department of Nuclear Medicine, Graduate School of Medicine, Osaka City University 1- 4- 3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan Telephone: +81-6- 6645-3885, Fax: +81-6- 6646-0686, Joji Kawabe M.D., Ph.D E-mail: [email protected] Category ELF © 2020 Joji Kawabe Abstract A man in his 70s underwent FDG-PET 6 months after Covid-19 pneumonia was cured. The cure was confirmed with a negative polymerase chain reaction (PCR) test. At the time of PET examination, CRP was 0.06 mg / dL, WBC number was 6300 / μL, which indicates no inflammatory reaction was observed, and no obvious symptoms such as fever were observed. CT images of FDG-PET / CT showed ground glass opacities (GGO) on the right lung S6. In FDG-PET images, moderate FDG abnormal accumulation were observed in the same area, and the Standardized uptake value (SUV) max was 3.0. Many investigators reports abnormal high FDG uptake by active Covid-19 pneumonia. It should be noted that abnormal FDG accumulation by GGOs may continue to be observed after healing. Key words Covid-19, pneumonia, FDG-PET, abnormal accumulation, post-healing.

(2) Japanese Archive of cases conference of clinical nuclear medicine 02, 2020. P. 16. Ethical comments Written informed consent was obtained from an individual participant included in this study in accordance with the Code of Ethics of the World Medical Association. All procedures performed in this retrospective study were in accordance with the ethical standards of our institutional research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments our comparable ethical standards. Conflicts of interest None.

(3) Japanese Archive of cases conference of clinical nuclear medicine 02, 2020. P. 17. Fig.1 Maximum Intensity Projection (MIP) image shows moderate FDG abnormal accumulation in the lower right lung field, but no FDG abnormal accumulation in other areas, including the mediastinal lymph nodes, indicating the presence of active inflammation..

(4) Japanese Archive of cases conference of clinical nuclear medicine 02, 2020. P. 18. Fig.2 CT imageｓ of the lung field condition (left) show ground glass opacities (GGOs) on the right S6 region. Overlapping images (middle) and FDG-PET (right) images show that these lesions have moderate glucose metabolism of about 3 at SUVmax. In active phase of Covid-19 pneumonia, chest CT show GGOs with severe pattern to consolidative opacities[1, 2]. High FDG abnormal accumulation is observed in these GGOs and mediastinal lymph nodes[1-5]. FDG-PET is also used to detect inflammatory diseases[4]. In acute inflammation or chest infection, activated neutrophils are heavily dependent on anaerobic glycolysis, requiring increased glucose and resulting in high FDG uptake. Granulocytes and macrophages also facilitate glucose transport under chronic conditions[5]. It has been reported that residual GGOs are observed on CT about 2 months after healing[1]. In this case, GGOs remained even 6 months after healing. FDG accumulation of GGOs in these chronic phases may reflect the still presence of not a few granulocytes and macrophages. In conclusion, it should be noted that abnormal FDG accumulation by these GGOs may continue to be observed after healing..

(5) Japanese Archive of cases conference of clinical nuclear medicine 02, 2020. P. 19. References 1. Fu C, Zhang W, Li H, Bai Y, Bae KT, Wang M, et al. FDG PET/CT evaluation of a patient recovering from COVID-19. Eur J Nucl Med Mol Imaging. 2020;47:2703-5. doi:10.1007/s00259-020-04958-w. 2. Qin C, Liu F, Yen TC, Lan X. (18)F-FDG PET/CT findings of COVID-19: a series of four highly suspected cases. Eur J Nucl Med Mol Imaging. 2020;47:1281-6. doi:10.1007/s00259-020-04734-w. 3. Ferrando-Castagnetto F, Wakfie-Corieh CG, Garcia AMB, Garcia-Esquinas MG, Caro RMC, Delgado JLC. Incidental and simultaneous finding of pulmonary thrombus and COVID-19 pneumonia in a cancer patient derived to (18)F-FDG PET/CT. New pathophysiological insights from hybrid imaging. Radiol Case Rep. 2020;15:1803-5. doi:10.1016/j.radcr.2020.07.032. 4. Capitanio S, Nordin AJ, Noraini AR, Rossetti C. PET/CT in nononcological lung diseases: current applications and future perspectives. Eur Respir Rev. 2016;25:247-58. doi:10.1183/16000617.0051-2016. 5. Deng Y, Lei L, Chen Y, Zhang W. The potential added value of FDG PET/CT for COVID-19 pneumonia. Eur J Nucl Med Mol Imaging. 2020;47:1634-5. doi:10.1007/s00259020-04767-1..

(6)