Coronavirus Disease 2019 (COVID-19) in Molecular Imaging: A systematic review of incidental detection of SARS-CoV-2 pneumonia on PET studies

Rafiee, Faranak; Keshavarz, Pedram; Katal, Sanaz; Assadi, Majid; Nejati, Seyed Faraz; Sadabad, Faranak Ebrahimian; Gholamrezanezhad, Ali

PURPOSE: There have been several reports of the incidental detection of SARS-CoV-2 pneumonia on Positron Emission Tomography/Computed Tomography (PET/CT) studies, which represent the potential role of molecular imaging in detection and management of coronavirus disease 2019 (COVID-19). Here, we systematically review the value of PET/CT in this setting. MATERIALS AND METHODS: We conducted a systematic search on June 23, 2020, for PET studies with findings suggestive of COVID-19. Web of Science, PubMed, Scopus, EMBASE, and Google Scholar databases were used. Patients with at least one PET/CT imaging evaluation were included in the study. RESULTS: Fifty-two patients in 30 publications with a mean age of 60 ± 12.74 (age range; 27-87) were included in this study, of which 28(53.8%) were male, and 19(36.5%) were female. PET/CT was performed with (18)F-FDG for 49(94.2%), (18)F-choline for 2(3.8%), and (68)Ga-PSMA for 1 (1.9%) patients. The mean SUV max of pulmonary lesions with (18)F-FDG uptake was 4.9 ± 2.3. Moreover, 39(75%) cases had an underlying malignancy, including 18 different type of primary cancers and 6(11.5%) patients with metastatic disease. The most common pulmonary findings in PET/CT were bilateral hypermetabolic GGOs 39(75%), consolidation 18(34.6%), and interlobular thickening 4(7.6%). In addition, mediastinal 14(27%) and hilar 10(19.2%) lymph node involvement with increased metabolic activity were frequently identified. CONCLUSION: Early diagnosis of SARS-CoV-2 pneumonia is not only crucial for both appropriate patient management but also helps to ensure appropriate post-exposure precautions are implemented for the department and hospital staff and those who have been in contact with the patient.