Rubidium-82 PET/CT in COVID-19

de Burgt, Alina van; Smit, Frits; Anten, Sander

A 56-year-old man presented to the emergency department with shortness of breath during the COVID-19 pandemic. Chest computed tomography angiography (CTa) showed bilateral peripheral ground-glass opacifications classified as CO-RADS 5, but no pulmonary embolism. To analyze the possibility of CTaundetectable pulmonary microthrombi and to rule out cardiac perfusion abnormalities, we decided to perform a rubidium-82 (82Rb) PET/CT. 82Rb PET/CT imaging in this patient yielded uptake in the pulmonary areas of ground-glass opacification and showed. Moreover, higher 82Rb uptake was shown in the lobe with the highest density on CT. The ejection fraction was normal (56%) and no pulmonary embolism or other defects were detected. To our knowledge, this is the first time 82Rb PET/CT was performed for suspected pulmonary microthrombi in a COVID-19 patient. This case report shows corresponding findings between 82Rb PET/CT and CTa imaging without and does not show any signs of microthrombi despite the elevated d-dimer. Even in the Response to Reviewers (without Author Details) areas of profound groundglass opacifications, the increased 82Rb uptake indicates that perfusion is adequate to acquire 82Rb uptake in the de pulmonary cells. 82Rb PET/CT is a promising imaging technique and might extend the diagnostic potential of conventional nuclear and radiological imaging imaging techniques as CTa in detecting pulmonary microthrombi or other minor perfusion defects. To show sufficient evidence for the use of 82Rb PET/CT in clinical practice for COVID-19, validation should take place in a future prospective clinical trial, studying a large patient cohort.