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Lau CY, Martinez-Orengo N, Lyndaker A, Flavahan K, Johnson RF, Shah S, Hammoud DA. Advances and Challenges in Molecular Imaging of Viral Infections. J Infect Dis 2023; 228:S270-S280. [PMID: 37788495 PMCID: PMC10547465 DOI: 10.1093/infdis/jiad247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
Molecular imaging of viral infection, using a variety of advanced imaging techniques such as optical and nuclear imaging, can and has been used for direct visualization of the virus as well as assessment of virus-host interactions. Unlike imaging of other pathogens such as bacteria and fungi, challenging aspects of imaging viral infections include the small size of viruses, the complexity of viral infection animal models (eg, species dependence), and the high-level containment needs for many high-consequence pathogens, among others. In this review, using representative viral infections, we discuss how molecular imaging can reveal real-time infection dynamics, improve our understanding of disease pathogenesis, and guide optimization of treatment and prevention strategies. Key findings from human and animal studies are highlighted.
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Affiliation(s)
- Chuen-Yen Lau
- HIV Dynamics and Replication Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Neysha Martinez-Orengo
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Anna Lyndaker
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Kelly Flavahan
- Center for Infection and Inflammation Imaging Research, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Reed F Johnson
- SARS-CoV-2 Virology Core, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Swati Shah
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Dima A Hammoud
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
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[18F]FDG PET/CT in Short-Term Complications of COVID-19: Metabolic Markers of Persistent Inflammation and Impaired Respiratory Function. Diagnostics (Basel) 2022; 12:diagnostics12040835. [PMID: 35453883 PMCID: PMC9025979 DOI: 10.3390/diagnostics12040835] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 01/01/2023] Open
Abstract
SARS-CoV-2 virus infects organs other than the lung, such as mediastinal lymph nodes, spleen, and liver, but, to date, metabolic imaging studies obtained in short-term follow-ups of patients hospitalized with severe COVID-19 infection are rare. Our objective was to evaluate the usefulness of [18F]FDG-PET/CT in the short-term follow-up of patients admitted for COVID-19 pneumonia and to explore the association of the findings with clinical prognostic markers. The prospective study included 20 patients with COVID-19 pneumonia (November 2020–March 2021). Clinical and laboratory test findings were gathered at admission, 48–72 h post-admission, and 2–3 months post-discharge, when [18F]FDG-PET/CT and respiratory function tests were performed. Lung volumes, spirometry, lung diffusion capacity for carbon monoxide (DLCO), and respiratory muscle strength were measured. Volumetric [18F]FDG-PET/CT results were correlated with laboratory and respiratory parameters. Eleven [18F]FDG-PET/CT (55%) were positive, with hypermetabolic mediastinal lymphadenopathy in 90.9%. Mediastinal lesion’s SUVpeak was correlated with white cells’ count. Eleven (55%) patients had impaired respiratory function, including reduced DLCO (35%). SUVpeak was correlated with %predicted-DLCO. TLG was negatively correlated with %predicted-DLCO and TLC. In the short-term follow-up of patients hospitalized for COVID-19 pneumonia, [18F]FDG-PET/CT findings revealed significant detectable inflammation in lungs and mediastinal lymph nodes that correlated with pulmonary function impairment in more than half of the patients.
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Yao J, Liu J, Bi L, Huang Y, Wang L, Zhang F, Wang Y, Jin H. The imaging quantification of multiple organs by dynamic 18F-FDG PET/CT in discharged COVID-19 patients: A prospective pilot study. Int J Med Sci 2022; 19:1539-1547. [PMID: 36185330 PMCID: PMC9515694 DOI: 10.7150/ijms.73801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/16/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose: To early identify abnormal lesions by applying the 18F-FDG PET dynamic modeling approach for discharged patients recovering from COVID-19. Methods: Seven discharged COVID-19 patients (COVID-19 group), twelve healthy volunteers (control group 1), and eight cancer patients with normal pulmonary function (control group 2) were prospectively enrolled. Control group 1 completed static 18F-FDG PET/CT only; COVID-19 group and control group 2 completed 60-min dynamic 18F-FDG PET/CT. Among COVID-19 group and control group 2, the uptake of FDG on the last frame (at 55-60 min) of dynamic scans was used for static analysis. Prior to performing scans, COVID-19 patients provided negative real-time Reverse Transcription-Polymerase Chain Reaction (rRT-PCR) of SARS-CoV-2, normal lung functions test, and normal laboratory test. Organ-to-liver standard uptake ratio (OLR, i.e. SUVmax evaluated organ/ SUVmax liver) from conventional static data and Patlak analysis based on the dynamic modeling to calculate the 18F-FDG net uptake rate constant (Ki) were performed. Results: Compared to the control groups, COVID-19 patients at two to three months after discharge still maintained significantly higher Ki values in multiple organs (including lung, bone marrow, lymph nodes, myocardium and liver), although results for regular OLR measurements were normal for all discharged COVID-19 patients. Taking the image of lung as an example, the differences of SUVmax images between COVID-19 group and control group were hard to distinguish. In contrast, a high 18F-FDG signal of the lung among the COVID-19 group was observed for Ki images. Conclusion: The Ki from 18F-FDG PET/CT dynamic imaging quantification might contribute to identifying residual lesions for COVID-19 survivors. Trial registration: The trial is registered with ClinicalTrials.gov, number NCT04519255 (IRB-approved number, K52-1).
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Affiliation(s)
- Jijin Yao
- Guangdong Provincial Key Laboratory of Biomedical Imaging, Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China.,Department of Head and Neck Oncology, Cancer Center, Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China
| | - Jing Liu
- Department of Respiratory Medicine, Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China
| | - Lei Bi
- Guangdong Provincial Key Laboratory of Biomedical Imaging, Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China
| | - Yiying Huang
- Department of Respiratory Medicine, Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China
| | - Lu Wang
- Department of Information Technology, Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China
| | - Fanwei Zhang
- Department of Nuclear Medicine, Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China
| | - Ying Wang
- Department of Nuclear Medicine, Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China
| | - Hongjun Jin
- Guangdong Provincial Key Laboratory of Biomedical Imaging, Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China
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Rabiee B, Eibschutz LS, Asadollahi S, Gupta A, Akhlaghpoor S, Gholamrezanezhad A. The role of imaging techniques in understanding and evaluating the long-term pulmonary effects of COVID-19. Expert Rev Respir Med 2021; 15:1525-1537. [PMID: 34730039 DOI: 10.1080/17476348.2021.2001330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Limited data exist regarding the long-term pulmonary sequelae of COVID-19. Identifying features utilizing multiple imaging modalities engenders a clearer picture of the illness's long-term consequences. AREAS COVERED This review encompasses the common pulmonary findings associated with different imaging modalities during acute and late remission stages of COVID-19 pneumonia. EXPERT OPINION Chest x-ray, a common preliminary diagnostic imaging technique, is not optimal for extended care due to limited tissue contrast resolution providing suboptimal assessment of pulmonary pathology and subtle interval changes. Ultrasound may be utilized on a case-by-case basis in certain patient populations, or in countries with limited resources. Chest CT's accessibility, high tissue contrast and spatial resolution make it the foremost modality for long-term COVID-19 follow-up. While MRI can viably monitor extrapulmonary disease due to its lack of radiation and high inherent soft-tissue contrast, it has limited pulmonary utility due to motion artifact and alveolar gas decreasing lung signal. Although 18F-FDG-PET/CT is costly and has limited specificity, it can provide molecular level data and inflammation quantification. Lung perfusion scintigraphy may also explain COVID-19 induced thromboembolic events and persistent dyspnea despite normal structural imaging and testing results. Correlating the long-term pulmonary findings of COVID-19 with each imaging modality is essential in elucidating the post-recovery course.
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Affiliation(s)
- Behnam Rabiee
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA.,Trinity Health Mid-Atlantic Nazareth Hospital, Philadelphia, PA, USA
| | - Liesl S Eibschutz
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA
| | - Shadi Asadollahi
- Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA
| | - Amit Gupta
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Shahram Akhlaghpoor
- Department of Interventional Radiology, Pardis Noor Medical Center, Tehran, Iran
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA
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Jin C, Luo X, Qian S, Zhang K, Gao Y, Zhou R, Cen P, Xu Z, Zhang H, Tian M. Positron emission tomography in the COVID-19 pandemic era. Eur J Nucl Med Mol Imaging 2021; 48:3903-3917. [PMID: 34013405 PMCID: PMC8134823 DOI: 10.1007/s00259-021-05347-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/29/2021] [Indexed: 12/24/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has become a major public health problem worldwide since its outbreak in 2019. Currently, the spread of COVID-19 is far from over, and various complications have roused increasing awareness of the public, calling for novel techniques to aid at diagnosis and treatment. Based on the principle of molecular imaging, positron emission tomography (PET) is expected to offer pathophysiological alternations of COVID-19 in the molecular/cellular perspectives and facilitate the clinical management of patients. A number of PET-related cases and research have been reported on COVID-19 over the past one year. This article reviews the current studies of PET in the diagnosis and treatment of COVID-19, and discusses potential applications of PET in the development of management strategy for COVID-19 patients in the pandemic era.
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Affiliation(s)
- Chentao Jin
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Zhejiang, 310009, Hangzhou, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Xiaoyun Luo
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Zhejiang, 310009, Hangzhou, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Shufang Qian
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Zhejiang, 310009, Hangzhou, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Kai Zhang
- Laboratory for Pathophysiological and Health Science, RIKEN Center for Biosystems Dynamics Research, Kobe, Hyogo, Japan
| | - Yuanxue Gao
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Zhejiang, 310009, Hangzhou, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Rui Zhou
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Zhejiang, 310009, Hangzhou, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Peili Cen
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Zhejiang, 310009, Hangzhou, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Zhoujiao Xu
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Zhejiang, 310009, Hangzhou, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Hong Zhang
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Zhejiang, 310009, Hangzhou, China.
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China.
- College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China.
- Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China.
| | - Mei Tian
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Zhejiang, 310009, Hangzhou, China.
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China.
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Churruca M, Martínez-Besteiro E, Couñago F, Landete P. COVID-19 pneumonia: A review of typical radiological characteristics. World J Radiol 2021; 13:327-343. [PMID: 34786188 PMCID: PMC8567439 DOI: 10.4329/wjr.v13.i10.327] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/08/2021] [Accepted: 09/14/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) was first discovered after unusual cases of severe pneumonia emerged by the end of 2019 in Wuhan (China) and was declared a global public health emergency by the World Health Organization in January 2020. The new pathogen responsible for the infection, genetically similar to the beta-coronavirus family, is known as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), and the current gold standard diagnostic tool for its detection in respiratory samples is the reverse transcription-polymerase chain reaction test. Imaging findings on COVID-19 have been widely described in studies published throughout last year, 2020. In general, ground-glass opacities and consolidations, with a bilateral and peripheral distribution, are the most typical patterns found in COVID-19 pneumonia. Even though much of the literature focuses on chest computed tomography (CT) and X-ray imaging and their findings, other imaging modalities have also been useful in the assessment of COVID-19 patients. Lung ultrasonography is an emerging technique with a high sensitivity, and thus useful in the initial evaluation of SARS-CoV-2 infection. In addition, combined positron emission tomography-CT enables the identification of affected areas and follow-up treatment responses. This review intends to clarify the role of the imaging modalities available and identify the most common radiological manifestations of COVID-19.
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Affiliation(s)
- María Churruca
- Pulmonology Department, Hospital Universitario de La Princesa, Madrid 28006, Spain
| | | | - Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Madrid 28223, Spain
- Department of Radiation Oncology, Hospital La Luz, Madrid 28003, Spain
- Clinical Department, Faculty of Biomedicine,Universidad Europea de Madrid, Madrid 28670, Spain
| | - Pedro Landete
- Department of Pneumology, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid 28006, Spain
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Rodríguez-Alfonso B, Ruiz Solís S, Silva-Hernández L, Pintos Pascual I, Aguado Ibáñez S, Salas Antón C. 18F-FDG-PET/CT in SARS-CoV-2 infection and its sequelae. Rev Esp Med Nucl Imagen Mol 2021; 40:299-309. [PMID: 34340958 PMCID: PMC8316133 DOI: 10.1016/j.remnie.2021.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 12/12/2022]
Abstract
In recent months, much of the scientific efforts have focused on research on SARSCoV-2 infection and its consequences in humans. Still, many aspects remain unknown. It is known that the damage caused by SARS-CoV-2 is multifactorial and that its extension goes beyond lung inflammation and the acute phase, with the appearance of numerous complications and sequelae. To date, knowledge about the usefulness of 18F-FDG-PET/CT in the acute phase has been limited to the incidental detection of SARS-CoV-2 unsuspected pneumonia. Recent studies have been appearing collecting the findings of 18F-FDG-PET/CT in long COVID-19 or persistent COVID-19 state as well as the alterations caused after mass vaccination of the population in the metabolic studies. This work aims to review the existing literature focusing on these three issues and to briefly present our own preliminary experience.
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Affiliation(s)
- B Rodríguez-Alfonso
- Servicio de Medicina Nuclear del Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
| | - S Ruiz Solís
- Servicio de Medicina Nuclear del Hospital Universitario 12 de Octubre, Madrid, Spain
| | - L Silva-Hernández
- Servicio de Neurología del Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - I Pintos Pascual
- Servicio de Medicina Interna del Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - S Aguado Ibáñez
- Servicio de Neumología del Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - C Salas Antón
- Servicio de Anatomía Patológica del Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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Rodríguez-Alfonso B, Ruiz Solís S, Silva-Hernández L, Pintos Pascual I, Aguado Ibáñez S, Salas Antón C. [ 18F-FDG-PET/CT in SARS-CoV-2 infection and its sequelae]. Rev Esp Med Nucl Imagen Mol 2021; 40:299-309. [PMID: 35368611 PMCID: PMC8272978 DOI: 10.1016/j.remn.2021.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 12/12/2022]
Abstract
In recent months, much of the scientific efforts have focused on research on SARSCoV-2 infection and its consequences in humans. Still, many aspects remain unknown. It is known that the damage caused by SARS-CoV-2 is multifactorial and that its extension goes beyond lung inflammation and the acute phase, with the appearance of numerous complications and sequelae. To date, knowledge about the usefulness of 18F-FDG-PET/CT in the acute phase has been limited to the incidental detection of SARS-CoV-2 unsuspected pneumonia. Recent studies have been appearing collecting the findings of 18F-FDG- PET/CT in long COVID-19 or persistent COVID-19 state as well as the alterations caused after mass vaccination of the population in the metabolic studies. This work aims to review the existing literature focusing on these three issues and to briefly present our own preliminary experience.
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Affiliation(s)
- B Rodríguez-Alfonso
- Servicio de Medicina Nuclear del Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - S Ruiz Solís
- Servicio de Medicina Nuclear del Hospital Universitario 12 de Octubre, Madrid, España
| | - L Silva-Hernández
- Servicio de Neurología del Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - I Pintos Pascual
- Servicio de Medicina Interna del Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - S Aguado Ibáñez
- Servicio de Neumología del Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - C Salas Antón
- Servicio de Anatomía Patológica del Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
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Rivera-Sotelo N, Vargas-Del-Angel RG, Ternovoy SK, Roldan-Valadez E. Global research trends in COVID-19 with MRI and PET/CT: a scoping review with bibliometric and network analyses. Clin Transl Imaging 2021; 9:625-639. [PMID: 34414137 PMCID: PMC8364406 DOI: 10.1007/s40336-021-00460-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/04/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To identify and evaluate the indexed studies that allow us to understand the implications of imaging studies in MRI and PET/CT related to COVID-19 research. METHODS Scoping review. Articles in PubMed, Scopus, and Web of Science (WoS) were scanned from 2019 to 2021 with COVID-19, MRI, and PET-CT as keywords. EndNote software and manual checking removed the duplicated references. Our assessment includes citation, bibliometric, keyword network, and statistical analyses using descriptive statistics and correlations. Highlighted variables were publication year, country, journals, and authorship. RESULTS Only 326 papers were included. The most cited article reached 669 cites; this number represented 21.71% of 3081 citations. The top-15 cited authors received 1787 citations, which represented 58% of the total cites. These authors had affiliations from ten countries (Belgium, China, France, Italy, Japan, Spain, Sweden, Turkey, United Kingdom (UK), and the USA). The top-30 journals were cited 2762 times, representing 89.65% of the total cites. Only five journals were cited more than 100 times; Int J Infect Dis had the most significant number of citations (674). Some of the unexpected keywords were encephalitis, stroke, microbleeds, myocarditis. CONCLUSION COVID-19 pandemic is still spreading worldwide, and the knowledge about its different facets continues advancing. MRI and PET/CT are being used in more than 50% of the selected studies; research trends span seven categories, no only the diagnostic but others like socio-economic impact and pathogenesis Developed countries had an advantage by having hospitals with more resources, including MRI and PET/CT facilities in the same institution to supplement basic assessment in patients with COVID-19. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40336-021-00460-x.
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Affiliation(s)
- Nathaly Rivera-Sotelo
- Directorate of Research, Hospital General de Mexico “Dr Eduardo Liceaga”, 06720 Mexico City, Mexico
| | | | - Sergey K. Ternovoy
- Department of Radiology, A.L. Myasnikov Research Institute of Clinical Cardiology of National Medical Research Center, Moscow, Russia
- Department of Radiology, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119992 Moscow, Russia
| | - Ernesto Roldan-Valadez
- Directorate of Research, Hospital General de Mexico “Dr Eduardo Liceaga”, 06720 Mexico City, Mexico
- Department of Radiology, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119992 Moscow, Russia
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Casali M, Lauri C, Altini C, Bertagna F, Cassarino G, Cistaro A, Erba AP, Ferrari C, Mainolfi CG, Palucci A, Prandini N, Baldari S, Bartoli F, Bartolomei M, D’Antonio A, Dondi F, Gandolfo P, Giordano A, Laudicella R, Massollo M, Nieri A, Piccardo A, Vendramin L, Muratore F, Lavelli V, Albano D, Burroni L, Cuocolo A, Evangelista L, Lazzeri E, Quartuccio N, Rossi B, Rubini G, Sollini M, Versari A, Signore A. State of the art of 18F-FDG PET/CT application in inflammation and infection: a guide for image acquisition and interpretation. Clin Transl Imaging 2021; 9:299-339. [PMID: 34277510 PMCID: PMC8271312 DOI: 10.1007/s40336-021-00445-w] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/19/2021] [Indexed: 02/06/2023]
Abstract
AIM The diagnosis, severity and extent of a sterile inflammation or a septic infection could be challenging since there is not one single test able to achieve an accurate diagnosis. The clinical use of 18F-fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) imaging in the assessment of inflammation and infection is increasing worldwide. The purpose of this paper is to achieve an Italian consensus document on [18F]FDG PET/CT or PET/MRI in inflammatory and infectious diseases, such as osteomyelitis (OM), prosthetic joint infections (PJI), infective endocarditis (IE), prosthetic valve endocarditis (PVE), cardiac implantable electronic device infections (CIEDI), systemic and cardiac sarcoidosis (SS/CS), diabetic foot (DF), fungal infections (FI), tuberculosis (TBC), fever and inflammation of unknown origin (FUO/IUO), pediatric infections (PI), inflammatory bowel diseases (IBD), spine infections (SI), vascular graft infections (VGI), large vessel vasculitis (LVV), retroperitoneal fibrosis (RF) and COVID-19 infections. METHODS In September 2020, the inflammatory and infectious diseases focus group (IIFG) of the Italian Association of Nuclear Medicine (AIMN) proposed to realize a procedural paper about the clinical applications of [18F]FDG PET/CT or PET/MRI in inflammatory and infectious diseases. The project was carried out thanks to the collaboration of 13 Italian nuclear medicine centers, with a consolidate experience in this field. With the endorsement of AIMN, IIFG contacted each center, and the pediatric diseases focus group (PDFC). IIFG provided for each team involved, a draft with essential information regarding the execution of [18F]FDG PET/CT or PET/MRI scan (i.e., indications, patient preparation, standard or specific acquisition modalities, interpretation criteria, reporting methods, pitfalls and artifacts), by limiting the literature research to the last 20 years. Moreover, some clinical cases were required from each center, to underline the teaching points. Time for the collection of each report was from October to December 2020. RESULTS Overall, we summarized 291 scientific papers and guidelines published between 1998 and 2021. Papers were divided in several sub-topics and summarized in the following paragraphs: clinical indications, image interpretation criteria, future perspectivess and new trends (for each single disease), while patient preparation, image acquisition, possible pitfalls and reporting modalities were described afterwards. Moreover, a specific section was dedicated to pediatric and PET/MRI indications. A collection of images was described for each indication. CONCLUSIONS Currently, [18F]FDG PET/CT in oncology is globally accepted and standardized in main diagnostic algorithms for neoplasms. In recent years, the ever-closer collaboration among different European associations has tried to overcome the absence of a standardization also in the field of inflammation and infections. The collaboration of several nuclear medicine centers with a long experience in this field, as well as among different AIMN focus groups represents a further attempt in this direction. We hope that this document will be the basis for a "common nuclear physicians' language" throughout all the country. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40336-021-00445-w.
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Affiliation(s)
- Massimiliano Casali
- Nuclear Medicine Unit, Azienda Unità Sanitaria Locale IRCCS, Reggio Emilia, Italy
| | - Chiara Lauri
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Corinna Altini
- Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Francesco Bertagna
- Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Gianluca Cassarino
- Nuclear Medicine Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | | | - Anna Paola Erba
- Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Cristina Ferrari
- Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | | | - Andrea Palucci
- Department of Nuclear Medicine, “Ospedali Riuniti di Torrette” Hospital, Ancona, Italy
| | - Napoleone Prandini
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Centro Diagnostico Italiano, Milan, Italy
| | - Sergio Baldari
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and of Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Francesco Bartoli
- Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Mirco Bartolomei
- Nuclear Medicine Unit, Oncological Medical and Specialists Department, University Hospital of Ferrara, Ferrara, Italy
| | - Adriana D’Antonio
- Department of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy
| | - Francesco Dondi
- Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Patrizia Gandolfo
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Centro Diagnostico Italiano, Milan, Italy
| | - Alessia Giordano
- Department of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy
| | - Riccardo Laudicella
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and of Morpho-Functional Imaging, University of Messina, Messina, Italy
| | | | - Alberto Nieri
- Nuclear Medicine Unit, Oncological Medical and Specialists Department, University Hospital of Ferrara, Ferrara, Italy
| | | | - Laura Vendramin
- Nuclear Medicine Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Francesco Muratore
- Rheumatology Unit, Azienda Unità Sanitaria Locale IRCCS, Reggio Emilia, Italy
| | - Valentina Lavelli
- Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Domenico Albano
- Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Luca Burroni
- Department of Nuclear Medicine, “Ospedali Riuniti di Torrette” Hospital, Ancona, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy
| | - Laura Evangelista
- Nuclear Medicine Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Elena Lazzeri
- Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Natale Quartuccio
- Nuclear Medicine Unit, A.R.N.A.S. Civico di Cristina and Benfratelli Hospitals, Palermo, Italy
| | - Brunella Rossi
- Nuclear Medicine Unit, Department of Services, ASUR MARCHE-AV5, Ascoli Piceno, Italy
| | - Giuseppe Rubini
- Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Martina Sollini
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Annibale Versari
- Nuclear Medicine Unit, Azienda Unità Sanitaria Locale IRCCS, Reggio Emilia, Italy
| | - Alberto Signore
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, “Sapienza” University of Rome, Rome, Italy
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11
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Abstract
Soon after reports of a novel coronavirus capable of causing severe pneumonia surfaced in late 2019, expeditious global spread of the Severe Acute Respiratory Distress Syndrome Coronavirus 2 (SARS-CoV-2) forced the World Health Organization to declare an international state of emergency. Although best known for causing symptoms of upper respiratory tract infection in mild cases and fulminant pneumonia in severe disease, Coronavirus Disease 2019 (COVID-19) has also been associated with gastrointestinal, neurologic, cardiac, and hematologic presentations. Despite concerns over poor specificity and undue radiation exposure, chest imaging nonetheless remains central to the initial diagnosis and monitoring of COVID-19 progression, as well as to the evaluation of complications. Classic features on chest CT include ground-glass and reticular opacities with or without superimposed consolidations, frequently presenting in a bilateral, peripheral, and posterior distribution. More recently, studies conducted with MRI have shown excellent concordance with chest CT in visualizing typical features of COVID-19 pneumonia. For patients in whom exposure to ionizing radiation should be avoided, particularly pregnant patients and children, pulmonary MRI may represent a suitable alternative to chest CT. Although PET imaging is not typically considered among first-line investigative modalities for the diagnosis of lower respiratory tract infections, numerous reports have noted incidental localization of radiotracer in parenchymal regions of COVID-19-associated pulmonary lesions. These findings are consistent with data from Middle East Respiratory Syndrome-CoV cohorts which suggested an ability for 18F-FDG PET to detect subclinical infection and lymphadenitis in subjects without overt clinical signs of infection. Though highly sensitive, use of PET/CT for primary detection of COVID-19 is constrained by poor specificity, as well as considerations of cost, radiation burden, and prolonged exposure times for imaging staff. Even still, decontamination of scanner bays is a time-consuming process, and proper ventilation of scanner suites may additionally require up to an hour of downtime to allow for sufficient air exchange. Yet, in patients who require nuclear medicine investigations for other clinical indications, PET imaging may yield the earliest detection of nascent infection in otherwise asymptomatic individuals. Especially for patients with concomitant malignancies and other states of immunocompromise, prompt recognition of infection and early initiation of supportive care is crucial to maximizing outcomes and improving survivability.
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Key Words
- sars-cov, severe acute respiratory syndrome coronavirus
- covid-19, coronavirus disease 2019
- ct, computed tomography
- mri, magnetic resonance imaging
- pet, positron emission tomography
- ggo, ground-glass opacity
- rt-pcr, reverse transcription polymerase chain reaction
- 18f-fdg, 18f-labelled fluorodeoxyglucose
- suvmax, maximum standardized uptake
- mip, maximum intensity projection
- 68ga-psma, 68ga-labelled prostate-specific membrane antigen
- 18f-choline, 18f-labelled choline
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Affiliation(s)
- Brandon K K Fields
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States of America
| | - Natalie L Demirjian
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States of America; Department of Integrative Anatomical Sciences, University of Southern California, Los Angeles, CA 90033, United States of America
| | - Habibollah Dadgar
- Razavi Cancer Research Center, RAZAVI Hospital, Imam Reza International University, Mashhad, Iran
| | - Ali Gholamrezanezhad
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States of America; Department of Radiology, University of Southern California, Los Angeles, CA 90033, United States of America.
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12
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Dadgar H, Norouzbeigi N, Gholamrezanezhad A, Assadi M. Incidental Detections Suggestive of COVID-19 in Asymptomatic Patients Undergoing 68Ga-DOTATATE and 68Ga-PSMA-11 PET-CT Scan for Oncological Indications. Nuklearmedizin 2021; 60:106-108. [PMID: 33327007 PMCID: PMC8043668 DOI: 10.1055/a-1311-2856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Habibollah Dadgar
- The Cancer Research Center, Razavi Hospital, Imam Reza International University, Mashhad, Iran
| | - Nasim Norouzbeigi
- The Cancer Research Center, Razavi Hospital, Imam Reza International University, Mashhad, Iran
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), 1500 San Pablo Street, Los Angeles, CA 90033 USA
| | - Majid Assadi
- The Persian Gulf Nuclear Medicine Research Center, Department of Molecular Imaging and Radionuclide Therapy, Bushehr Medical University Hospital, Bushehr University of Medical Sciences, Bushehr, Iran
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13
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Sollini M, Morbelli S, Ciccarelli M, Cecconi M, Aghemo A, Morelli P, Chiola S, Gelardi F, Chiti A. Long COVID hallmarks on [18F]FDG-PET/CT: a case-control study. Eur J Nucl Med Mol Imaging 2021; 48:3187-3197. [PMID: 33677642 PMCID: PMC7937050 DOI: 10.1007/s00259-021-05294-3] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 03/01/2021] [Indexed: 12/13/2022]
Abstract
Purpose The present study hypothesised that whole-body [18F]FDG-PET/CT might provide insight into the pathophysiology of long COVID. Methods We prospectively enrolled 13 adult long COVID patients who complained for at least one persistent symptom for >30 days after infection recovery. A group of 26 melanoma patients with negative PET/CT matched for sex/age was used as controls (2:1 control to case ratio). Qualitative and semi-quantitative analysis of whole-body images was performed. Fisher exact and Mann-Whitney tests were applied to test differences between the two groups. Voxel-based analysis was performed to compare brain metabolism in cases and controls. Cases were further grouped according to prevalent symptoms and analysed accordingly. Results In 4/13 long COVID patients, CT images showed lung abnormalities presenting mild [18F]FDG uptake. Many healthy organs/parenchyma SUVs and SUV ratios significantly differed between the two groups (p ≤ 0.05). Long COVID patients exhibited brain hypometabolism in the right parahippocampal gyrus and thalamus (uncorrected p < 0.001 at voxel level). Specific area(s) of hypometabolism characterised patients with persistent anosmia/ageusia, fatigue, and vascular uptake (uncorrected p < 0.005 at voxel level). Conclusion [18F]FDG PET/CT acknowledged the multi-organ nature of long COVID, supporting the hypothesis of underlying systemic inflammation. Whole-body images showed increased [18F]FDG uptake in several “target” and “non-target” tissues. We found a typical pattern of brain hypometabolism associated with persistent complaints at the PET time, suggesting a different temporal sequence for brain and whole-body inflammatory changes. This evidence underlined the potential value of whole-body [18F]FDG PET in disclosing the pathophysiology of long COVID. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-021-05294-3.
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Affiliation(s)
- Martina Sollini
- Humanitas Research Hospital, IRCCS, via Manzoni 56, 20089, Rozzano (Milan), Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Milan, Pieve Emanuele, Italy
| | - Silvia Morbelli
- Nuclear Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Michele Ciccarelli
- Humanitas Research Hospital, IRCCS, via Manzoni 56, 20089, Rozzano (Milan), Italy
| | - Maurizio Cecconi
- Humanitas Research Hospital, IRCCS, via Manzoni 56, 20089, Rozzano (Milan), Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Milan, Pieve Emanuele, Italy
| | - Alessio Aghemo
- Humanitas Research Hospital, IRCCS, via Manzoni 56, 20089, Rozzano (Milan), Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Milan, Pieve Emanuele, Italy
| | - Paola Morelli
- Humanitas Research Hospital, IRCCS, via Manzoni 56, 20089, Rozzano (Milan), Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Milan, Pieve Emanuele, Italy
| | - Silvia Chiola
- Humanitas Research Hospital, IRCCS, via Manzoni 56, 20089, Rozzano (Milan), Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Milan, Pieve Emanuele, Italy
| | - Fabrizia Gelardi
- Humanitas Research Hospital, IRCCS, via Manzoni 56, 20089, Rozzano (Milan), Italy.
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Milan, Pieve Emanuele, Italy.
| | - Arturo Chiti
- Humanitas Research Hospital, IRCCS, via Manzoni 56, 20089, Rozzano (Milan), Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Milan, Pieve Emanuele, Italy
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14
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Rafiee F, Keshavarz P, Katal S, Assadi M, Nejati SF, Ebrahimian Sadabad F, Gholamrezanezhad A. Coronavirus Disease 2019 (COVID-19) in Molecular Imaging: A Systematic Review of Incidental Detection of SARS-CoV-2 Pneumonia on PET Studies. Semin Nucl Med 2021; 51:178-191. [PMID: 33509374 PMCID: PMC7598766 DOI: 10.1053/j.semnuclmed.2020.10.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There have been several reports of the incidental detection of severe acute respiratory syndrome coronavirus 2 pneumonia on positron emission tomography/computed tomography (PET/CT) studies, which represent the potential role of molecular imaging in the detection and management of coronavirus disease 2019. Here, we systematically review the value of PET/CT in this setting. We conducted a systematic search on June 23, 2020, for PET studies with findings suggestive of coronavirus disease 2019. 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. 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. In 5 (9.7%) patients, gender was not reported. PET/CT was performed with 18F-fluorodeoxyglucose for 48 (92.3%), 18F-choline for 3 (5.8%), and 68Ga-PSMA for 1 (1.9%) patients. The mean SUV max of pulmonary lesions with 18F-fluorodeoxyglucose 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 ground-glass opacities in 39 (75%), consolidation in 18 (34.6%), and interlobular thickening in 4 (7.6%). In addition, mediastinal 14 (27%) and hilar 10 (19.2%) lymph node involvement with increased metabolic activity was frequently identified. Early diagnosis of severe acute respiratory syndrome coronavirus 2 pneumonia is not only crucial for both appropriate patient management but also helps to ensure appropriate postexposure precautions are implemented for the department and hospital staff and those who have been in contact with the patient.
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Affiliation(s)
- Faranak Rafiee
- Department of Radiology, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pedram Keshavarz
- Department of Radiology, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Radiology, Tbilisi State Medical University (TSMU), Tbilisi, Georgia
| | - Sanaz Katal
- Department of Nuclear Medicine/PET-CT, Kowsar Hospital, Shiraz, Iran
| | - Majid Assadi
- Department of Molecular Imaging and Radionuclide Therapy (MIRT), The Persian Gulf Nuclear Medicine Research Center, Bushehr Medical University Hospital, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Seyed Faraz Nejati
- Department of Radiology, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Faranak Ebrahimian Sadabad
- Department of Radiology, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Sothern California (USC), Los Angeles, CA.
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15
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Wakfie-Corieh CG, Blanes García AM, Ferrando-Castagnetto F, Valhondo-Rama R, Ortega Candil A, Rodríguez Rey C, Cabrera Martín MN, García-Esquinas MG, Couto Caro RM, Pedrera Canal M, Carreras Delgado JL. Assessment of extra-parenchymal lung involvement in asymptomatic cancer patients with COVID-19 pneumonia detected on 18F-FDG PET-CT studies. Eur J Nucl Med Mol Imaging 2021; 48:768-776. [PMID: 32901353 PMCID: PMC7478863 DOI: 10.1007/s00259-020-05019-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/31/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lung involvement in patients with coronavirus disease 2019 (COVID-19) undergoing PET-CT has been previously reported. However, FDG uptake outside lung parenchyma was poorly characterized in detail. We evaluated the extra-parenchymal lung involvement in asymptomatic cancer patients with COVID-19 pneumonia through 18F-FDG PET-CT. METHODS A total of 1079 oncologic 18F-FDG PET-CT were performed between February 2 and May 18, 2020. Confirmed COVID-19 pneumonia was defined as characteristic ground-glass bilateral CT infiltrates and positive genetic/serologic tests. Nonmetastatic extra-parenchymal lung PET-CT findings were evaluated through qualitative (visual), quantitative (measurements on CT), and semiquantitative (maximum standardized uptake value: SUVmax on PET) interpretation. Clinical data, blood tests, and PET-CT results were compared between patients with and without COVID-19 pneumonia. RESULTS A total of 23 18F-FDG PET-CT scans with pulmonary infiltrates suggestive of COVID-19 and available laboratory data were included: 14 positive (cases) and 9 negative (controls) for COVID-19 infection, representing a low prevalence of COVID-19 pneumonia (1.3%). Serum lactate dehydrogenase and D-dimers tended to be increased in COVID-19 cases. Extra-parenchymal lung findings were found in 42.9% of patients with COVID-19, most frequently as mediastinal and hilar nodes with 18F-FDG uptake (35.7%), followed by incidental pulmonary embolism in two patients (14.3%). In the control group, extra-pulmonary findings were observed in a single patient (11.1%) with 18F-FDG uptake located to mediastinal, hilar, and cervical nodes. Nasopharyngeal and hepatic SUVmax were similar in both groups. CONCLUSION In cancer patients with asymptomatic COVID-19 pneumonia, 18F-FDG PET-CT findings are more frequently limited to thoracic structures, suggesting that an early and silent distant involvement is very rare. Pulmonary embolism is a frequent and potentially severe finding raising special concern. PET-CT can provide new pathogenic insights about this novel disease.
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Affiliation(s)
| | - Alba María Blanes García
- Department of Nuclear Medicine, Hospital Clínico San Carlos, Av. Profesor Martín Lagos s/n., 28040, Madrid, Spain
| | | | - Raquel Valhondo-Rama
- Department of Nuclear Medicine, Hospital Clínico San Carlos, Av. Profesor Martín Lagos s/n., 28040, Madrid, Spain
| | - Aida Ortega Candil
- Department of Nuclear Medicine, Hospital Clínico San Carlos, Av. Profesor Martín Lagos s/n., 28040, Madrid, Spain
| | - Cristina Rodríguez Rey
- Department of Nuclear Medicine, Hospital Clínico San Carlos, Av. Profesor Martín Lagos s/n., 28040, Madrid, Spain
| | - María Nieves Cabrera Martín
- Department of Nuclear Medicine, Hospital Clínico San Carlos, Av. Profesor Martín Lagos s/n., 28040, Madrid, Spain
| | | | - Rosa María Couto Caro
- Department of Nuclear Medicine, Hospital Clínico San Carlos, Av. Profesor Martín Lagos s/n., 28040, Madrid, Spain
| | - María Pedrera Canal
- Department of Nuclear Medicine, Hospital Clínico San Carlos, Av. Profesor Martín Lagos s/n., 28040, Madrid, Spain
| | - José Luis Carreras Delgado
- Department of Nuclear Medicine, Hospital Clínico San Carlos, Av. Profesor Martín Lagos s/n., 28040, Madrid, Spain
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16
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Bai Y, Xu J, Chen L, Fu C, Kang Y, Zhang W, Fakhri GE, Gu J, Shao F, Wang M. Inflammatory response in lungs and extrapulmonary sites detected by [ 18F] fluorodeoxyglucose PET/CT in convalescing COVID-19 patients tested negative for coronavirus. Eur J Nucl Med Mol Imaging 2021; 48:2531-2542. [PMID: 33420914 PMCID: PMC7794623 DOI: 10.1007/s00259-020-05083-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/19/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in an ongoing global pandemic of coronavirus disease 2019 (COVID-19). The challenges associated with imaging infected patients have resulted, to date, in a paucity of metabolic imaging studies of patients with severe COVID-19 infection. Furthermore, it remains unclear if any abnormal metabolic events are taking place in patients who have recovered from COVID-19. PURPOSE To use [18F] fluorodeoxyglucose ([18F] FDG) positron emission tomography/computed tomography (PET/CT) to measure metabolic activity in inflamed organs of patients convalescing post severe COVID-19 infection. MATERIALS AND METHODS A prospective study was performed in seven convalescing patients who were recovering from severe COVID-19 infection in February 2020. Prior to [18F] FDG PET/CT, all patients had received two consecutive negative results of real-time reverse transcriptase polymerase chain reaction (RT-PCR) for SARS-CoV-2 nucleic acid. Clinical intake including symptoms, treatment, laboratory test results, and follow-up was performed. The PET/CT images of COVID-19 patients were compared to a control group of patients that were matched for age and sex. RESULTS Residual pulmonary lesions were present in all patients and maximum standard uptake value (SUVmax), average standard uptake value (SUVavg), maximum CT intensity (CTmax), and average CT intensity (CTavg) were all significantly greater than in the control group (p < 0.01 for all). In addition, SUVmax and SUVavg were significantly greater in the mediastinal lymph node and liver, and SUVmax was significantly greater in the spleen, of COVID-19 patients compared with controls (p < 0.05 for all). For the spleen, SUVmax (r2 = 0.863, p = 0.003) and SUVavg (r2 = 0.797, p = 0.007) were significantly correlated with blood lymphocyte count, and which was below the normal range in five of the seven (71.4%) patients convalescing post severe COVID-19 infection. CONCLUSION [18F] FDG PET/CT quantitative analysis has shown that significant inflammation remained in lungs, mediastinal lymph nodes, spleen, and liver after two consecutive negative RT-PCR tests in patients convalescing post severe COVID-19 infection.
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Affiliation(s)
- Yan Bai
- Department of Medical Imaging, Henan Provincial People's Hospital & the People's Hospital of Zhengzhou University, No. 7 Weiwu Road, Zhengzhou, 450003, Henan, China
| | - Junling Xu
- Department of Nuclear Medicine, Henan Provincial People's Hospital & the People's Hospital of Zhengzhou University, No. 7 Weiwu Road, Zhengzhou, 450003, Henan, China
| | - Lijuan Chen
- Department of Medical Imaging, Henan Provincial People's Hospital & the People's Hospital of Zhengzhou University, No. 7 Weiwu Road, Zhengzhou, 450003, Henan, China
| | - Chang Fu
- Department of Nuclear Medicine, Henan Provincial People's Hospital & the People's Hospital of Zhengzhou University, No. 7 Weiwu Road, Zhengzhou, 450003, Henan, China
| | - Yi Kang
- Department of Infectious Diseases, Henan Provincial People's Hospital & the People's Hospital of Zhengzhou University, No. 7 Weiwu Road, Zhengzhou, 450003, Henan, China
| | - Weifeng Zhang
- Department of Nuclear Medicine, Henan Provincial People's Hospital & the People's Hospital of Zhengzhou University, No. 7 Weiwu Road, Zhengzhou, 450003, Henan, China
| | - Georges Ei Fakhri
- Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Jianqin Gu
- Department of General Practice, Henan Provincial People's Hospital & the People's Hospital of Zhengzhou University, No. 7 Weiwu Road, Zhengzhou, 450003, Henan, China
| | - Fengmin Shao
- Department of Nephrology, Henan Provincial People's Hospital & the People's Hospital of Zhengzhou University, No. 7 Weiwu Road, Zhengzhou, 450003, Henan, China
| | - Meiyun Wang
- Department of Medical Imaging, Henan Provincial People's Hospital & the People's Hospital of Zhengzhou University, No. 7 Weiwu Road, Zhengzhou, 450003, Henan, China.
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17
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Dietz M, Chironi G, Claessens YE, Farhad RL, Rouquette I, Serrano B, Nataf V, Hugonnet F, Paulmier B, Berthier F, Keita-Perse O, Giammarile F, Perrin C, Faraggi M. COVID-19 pneumonia: relationship between inflammation assessed by whole-body FDG PET/CT and short-term clinical outcome. Eur J Nucl Med Mol Imaging 2021; 48:260-268. [PMID: 32712702 PMCID: PMC7382557 DOI: 10.1007/s00259-020-04968-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/19/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE [18F]-2-Fluoro-2-deoxy-D-glucose PET/CT (FDG PET/CT) is a sensitive and quantitative technic for detecting inflammatory process. Glucose uptake is correlated with an increased anaerobic glycolysis seen in activated inflammatory cells such as monocytes, lymphocytes, and granulocytes. The aim of the study was to assess the inflammatory status at the presumed peak of the inflammatory phase in non-critically ill patients requiring admission for COVID-19. METHODS Patients admitted with COVID-19 were prospectively enrolled. FDG PET/CT was performed from day 6 to day 14 of the onset of symptoms. Depending on FDG PET/CT findings, patients' profiles were classified as "inflammatory" or "low inflammatory." FDG PET/CT data were compared with chest CT evolution and short-term clinical outcome. All inflammatory sites were reported to screen potential extra-pulmonary tropism. RESULTS Thirteen patients were included. Maximum standardized uptake values ranged from 4.7 to 16.3 in lungs. All patients demonstrated increased mediastinal lymph nodes glucose uptake. Three patients (23%) presented mild nasopharyngeal, two patients (15%) bone marrow, and five patients (38%) splenic mild increase in glucose uptake. No patient had significant digestive focal or segmental glucose uptake. There was no significant physiological myocardial glucose uptake in all patients except one. There was no correlation between PET lung inflammatory status and chest CT evolution or short-term clinical outcome. CONCLUSION Inflammatory process at the presumed peak of the inflammatory phase in COVID-19 patients is obvious in FDG PET/CT scans. Glucose uptake is heterogeneous and typically focused on lungs. TRIAL REGISTRATION NCT04441489. Registered 22 June 2020 (retrospectively registered).
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Affiliation(s)
- Matthieu Dietz
- Nuclear Medicine Department, Centre Hospitalier Princesse Grace, 1 Avenue Pasteur, 98000, Monaco, Monaco
| | - Gilles Chironi
- Check-up Unit, Centre Hospitalier Princesse Grace, Monaco, Monaco
| | - Yann-Erick Claessens
- Department of Emergency Medicine, Centre Hospitalier Princesse Grace, Monaco, Monaco
| | - Ryan Lukas Farhad
- Pulmonary Department, Centre Hospitalier Princesse Grace, Monaco, Monaco
| | - Isabelle Rouquette
- Department of Intensive Care Medicine, Centre Hospitalier Princesse Grace, Monaco, Monaco
| | - Benjamin Serrano
- Medical Physics Department, Centre Hospitalier Princesse Grace, Monaco, Monaco
| | - Valérie Nataf
- Nuclear Medicine Department, Centre Hospitalier Princesse Grace, 1 Avenue Pasteur, 98000, Monaco, Monaco
| | - Florent Hugonnet
- Nuclear Medicine Department, Centre Hospitalier Princesse Grace, 1 Avenue Pasteur, 98000, Monaco, Monaco
| | - Benoît Paulmier
- Nuclear Medicine Department, Centre Hospitalier Princesse Grace, 1 Avenue Pasteur, 98000, Monaco, Monaco
| | - Frédéric Berthier
- Department of Biostatistics, Centre Hospitalier Princesse Grace, Monaco, Monaco
| | - Olivia Keita-Perse
- Infection disease Department, Centre Hospitalier Princesse Grace, Monaco, Monaco
| | - Francesco Giammarile
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
- Centre Leon Berard, Lyon, France
| | - Christophe Perrin
- Pulmonary Department, Centre Hospitalier Princesse Grace, Monaco, Monaco
| | - Marc Faraggi
- Nuclear Medicine Department, Centre Hospitalier Princesse Grace, 1 Avenue Pasteur, 98000, Monaco, Monaco.
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Victorio CBL, Novera W, Tham JY, Watanabe S, Vasudevan SG, Chacko AM. Peptide-Conjugated Phosphorodiamidate Morpholino Oligomers for In Situ Live-Cell Molecular Imaging of Dengue Virus Replication. Int J Mol Sci 2020; 21:E9260. [PMID: 33291644 PMCID: PMC7730579 DOI: 10.3390/ijms21239260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/15/2020] [Accepted: 12/01/2020] [Indexed: 01/01/2023] Open
Abstract
Current methods to detect and monitor pathogens in biological systems are largely limited by the tradeoffs between spatial context and temporal detail. A new generation of molecular tracking that provides both information simultaneously involves in situ detection coupled with non-invasive imaging. An example is antisense imaging that uses antisense oligonucleotide probes complementary to a target nucleotide sequence. In this study, we explored the potential of repurposing antisense oligonucleotides initially developed as antiviral therapeutics as molecular probes for imaging of viral infections in vitro and in vivo. We employed nuclease-resistant phosphorodiamidate synthetic oligonucleotides conjugated with cell-penetrating peptides (i.e., PPMOs) previously established as antivirals for dengue virus serotype-2 (DENV2). As proof of concept, and before further development for preclinical testing, we evaluated its validity as in situ molecular imaging probe for tracking cellular DENV2 infection using live-cell fluorescence imaging. Although the PPMO was designed to specifically target the DENV2 genome, it was unsuitable as in situ molecular imaging probe. This study details our evaluation of the PPMOs to assess specific and sensitive molecular imaging of DENV2 infection and tells a cautionary tale for those exploring antisense oligonucleotides as probes for non-invasive imaging and monitoring of pathogen infections in experimental animal models.
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Affiliation(s)
- Carla Bianca Luena Victorio
- Laboratory for Translational and Molecular Imaging, Cancer and Stem Cell Biology Programme, Duke-NUS Medical School, Singapore 169857, Singapore; (C.B.L.V.); (W.N.); (J.Y.T.)
| | - Wisna Novera
- Laboratory for Translational and Molecular Imaging, Cancer and Stem Cell Biology Programme, Duke-NUS Medical School, Singapore 169857, Singapore; (C.B.L.V.); (W.N.); (J.Y.T.)
| | - Jing Yang Tham
- Laboratory for Translational and Molecular Imaging, Cancer and Stem Cell Biology Programme, Duke-NUS Medical School, Singapore 169857, Singapore; (C.B.L.V.); (W.N.); (J.Y.T.)
| | - Satoru Watanabe
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore 169857, Singapore; (S.W.); (S.G.V.)
| | - Subhash G. Vasudevan
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore 169857, Singapore; (S.W.); (S.G.V.)
| | - Ann-Marie Chacko
- Laboratory for Translational and Molecular Imaging, Cancer and Stem Cell Biology Programme, Duke-NUS Medical School, Singapore 169857, Singapore; (C.B.L.V.); (W.N.); (J.Y.T.)
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19
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Totura A, Livingston V, Frick O, Dyer D, Nichols D, Nalca A. Small Particle Aerosol Exposure of African Green Monkeys to MERS-CoV as a Model for Highly Pathogenic Coronavirus Infection. Emerg Infect Dis 2020; 26:2835-2843. [PMID: 32744989 PMCID: PMC7706928 DOI: 10.3201/eid2612.201664] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Emerging coronaviruses are a global public health threat because of the potential for person-to-person transmission and high mortality rates. Middle East respiratory syndrome coronavirus (MERS-CoV) emerged in 2012, causing lethal respiratory disease in »35% of cases. Primate models of coronavirus disease are needed to support development of therapeutics, but few models exist that recapitulate severe disease. For initial development of a MERS-CoV primate model, 12 African green monkeys were exposed to 103, 104, or 105 PFU target doses of aerosolized MERS-CoV. We observed a dose-dependent increase of respiratory disease signs, although all 12 monkeys survived for the 28-day duration of the study. This study describes dose-dependent effects of MERS-CoV infection of primates and uses a route of infection with potential relevance to MERS-CoV transmission. Aerosol exposure of African green monkeys might provide a platform approach for the development of primate models of novel coronavirus diseases.
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20
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Landete P, Loaiza CAQ, Aldave-Orzaiz B, Muñiz SH, Maldonado A, Zamora E, Cerna ACS, Cerro ED, Alonso RC, Couñago F. Clinical features and radiological manifestations of COVID-19 disease. World J Radiol 2020; 12:247-260. [PMID: 33362916 PMCID: PMC7745468 DOI: 10.4329/wjr.v12.i11.247] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/24/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) was discovered after unusual cases of severe pneumonia emerged in December 2019 in Wuhan Province (China). Coronavirus is a family of single-stranded RNA viruses. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted from person to person. Although asymptomatic individuals can transmit the virus, symptomatic patients are more contagious. The incubation period ranges from 3-7 d and symptoms are mainly respiratory, including pneumonia or pulmonary embolism in severe cases. Elevated serum levels of interleukins (IL)-2, IL-6, IL-7 indicate the presence of cytokine release syndrome, which is associated with disease severity. The disease has three main phases: Viral infection, pulmonary involvement, and hyperinflammation. To date, no treatment has proved to be safe or effective. Chest X-ray and computed tomography (CT) are the primary imaging tests for diagnosis of SARS-CoV-2 pneumonia, follow-up, and detection of complications. The main radiological findings are ground-glass opacification and areas of consolidation. The long-term clinical course is unknown, although some patients may develop pulmonary fibrosis. Positron emission tomography-computed tomography (PET-CT) is useful to assess pulmonary involvement, to define the affected areas, and to assess treatment response. The pathophysiology and clinical course of COVID-19 infection remain poorly understood. However, patterns detected on CT and PET-CT may help to diagnose and guide treatment. In this mini review, we analyze the clinical manifestations and radiological findings of COVID-19 infection.
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Affiliation(s)
- Pedro Landete
- Department ofPulmonology, H. U. La Princesa, Madrid 28006, Spain
| | | | | | | | - Antonio Maldonado
- Department of Nuclear Medicine, Hospital Universitario Quironsalud Madrid, Madrid 28223, Spain
| | - Enrique Zamora
- Department ofPulmonology, H. U. La Princesa, Madrid 28006, Spain
| | | | - Elia del Cerro
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Pozuelo de Alarcón, Madrid 28223, Spain
- Department of Radiation Oncology, Hospital La Luz, Madrid 28003, Spain
- Department of Radiation Oncology, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid 28670, Spain
| | - Raquel Cano Alonso
- Department of Diagnostic Imaging, Hospital Universitario Quirón Madrid, Madrid 28223, Spain
| | - Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Pozuelo de Alarcón, Madrid 28223, Spain
- Department of Radiation Oncology, Hospital La Luz, Madrid 28003, Spain
- Department of Radiation Oncology, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid 28670, Spain
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21
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Ali SA, Abdelkawi MM. Incidentally recognized COVID-19 pneumonia in routine oncologic 18F-FDG PET/CT examinations: a local experience during pandemic era. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [PMCID: PMC7610243 DOI: 10.1186/s43055-020-00333-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background CT chest findings of COVID-19 pneumonia can be detected before the clinical symptoms become evident in many cases. In this work, we presented our experience in incidental detection of COVID-19-associated pneumonia in asymptomatic patients coming for routine oncologic 18F-FDG PET/CT examinations during the COVID-19 pandemic, which contribute in the detection of the affected patients early to be isolated and properly managed. We reported the cases with incidental finding of COVID-19 pneumonia among 764 asymptomatic patients who were referred for whole-body 18F-FDG PET/CT examinations for routine oncologic indications in the period between 15 March and 15 June 2020, and RT-PCR testing for them was requested for confirmation. Results Among the 764 scanned patients, we had recognized 87 patients (11.3%) having features of COVID-19 pneumonia. RT-PCR testing of them confirmed COVID-19 infection in 78 cases, yet 3 were negative and no RT-PCR testing was performed in 6 cases (only isolated and carefully monitored). Conclusion 18F-FDG PET/CT is sensitive for early COVID-19 detection, even in asymptomatic patients that guide proper management and also highlight the key role of a radiologist and the importance of applying safety measures in clinical services during the pandemic to minimize the spread of infection.
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22
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Scimeca M, Urbano N, Bonfiglio R, Montanaro M, Bonanno E, Schillaci O, Mauriello A. Imaging Diagnostics and Pathology in SARS-CoV-2-Related Diseases. Int J Mol Sci 2020; 21:6960. [PMID: 32971906 PMCID: PMC7554796 DOI: 10.3390/ijms21186960] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/09/2020] [Accepted: 09/21/2020] [Indexed: 01/18/2023] Open
Abstract
In December 2019, physicians reported numerous patients showing pneumonia of unknown origin in the Chinese region of Wuhan. Following the spreading of the infection over the world, The World Health Organization (WHO) on 11 March 2020 declared the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) outbreak a global pandemic. The scientific community is exerting an extraordinary effort to elucidate all aspects related to SARS-CoV-2, such as the structure, ultrastructure, invasion mechanisms, replication mechanisms, or drugs for treatment, mainly through in vitro studies. Thus, the clinical in vivo data can provide a test bench for new discoveries in the field of SARS-CoV-2, finding new solutions to fight the current pandemic. During this dramatic situation, the normal scientific protocols for the development of new diagnostic procedures or drugs are frequently not completely applied in order to speed up these processes. In this context, interdisciplinarity is fundamental. Specifically, a great contribution can be provided by the association and interpretation of data derived from medical disciplines based on the study of images, such as radiology, nuclear medicine, and pathology. Therefore, here, we highlighted the most recent histopathological and imaging data concerning the SARS-CoV-2 infection in lung and other human organs such as the kidney, heart, and vascular system. In addition, we evaluated the possible matches among data of radiology, nuclear medicine, and pathology departments in order to support the intense scientific work to address the SARS-CoV-2 pandemic. In this regard, the development of artificial intelligence algorithms that are capable of correlating these clinical data with the new scientific discoveries concerning SARS-CoV-2 might be the keystone to get out of the pandemic.
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Affiliation(s)
- Manuel Scimeca
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy;
- San Raffaele University, Via di Val Cannuta 247, 00166 Rome, Italy
- Saint Camillus International University of Health Sciences, Via di Sant’Alessandro, 8, 00131 Rome, Italy
| | - Nicoletta Urbano
- Nuclear Medicine Unit, Department of Oncohaematology, Policlinico “Tor Vergata”, viale oxford 81, 00133 Rome, Italy;
| | - Rita Bonfiglio
- Department of Experimental Medicine, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy; (R.B.); (M.M.); (E.B.); (A.M.)
- Fondazione Umberto Veronesi (FUV), Piazza Velasca 5, 20122 Milano, Italy
| | - Manuela Montanaro
- Department of Experimental Medicine, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy; (R.B.); (M.M.); (E.B.); (A.M.)
| | - Elena Bonanno
- Department of Experimental Medicine, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy; (R.B.); (M.M.); (E.B.); (A.M.)
- Diagnostica Medica’ & ‘Villa dei Platani’, Neuromed Group, 83100 Avellino, Italy
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy;
- IRCCS Neuromed, Via Atinense, 18, 8607 Pozzilli, Italy
| | - Alessandro Mauriello
- Department of Experimental Medicine, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy; (R.B.); (M.M.); (E.B.); (A.M.)
- Tor Vergata Oncoscience Research (TOR), University of Rome “Tor Vergata”, 00133 Rome, Italy
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23
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Minamimoto R, Hotta M, Ishikane M, Inagaki T. FDG-PET/CT images of COVID-19: a comprehensive review. Glob Health Med 2020; 2:221-226. [PMID: 33330811 PMCID: PMC7731428 DOI: 10.35772/ghm.2020.01056] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 12/28/2022]
Abstract
Following a lot of reports of coronavirus disease 2019 (COVID-19) CT images, the feature of FDG-PET/ CT imaging of COVID-19 was reported in several articles. Since FDG accumulates in activated inflammatory cells, FDG-PET/CT has huge potential for diagnosing and monitoring of inflammatory disease. However, FDG-PET/CT cannot be routinely used in an emergency setting and is not generally recommended as a first choice for diagnosis of infectious diseases. In this review, we demonstrate FDG-PET/CT imaging features of COVID-19, including our experience and current knowledge, and discuss the value of FDG-PET/CT in terms of estimating the pathologic mechanism.
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Affiliation(s)
- Ryogo Minamimoto
- Division of Nuclear Medicine, Department of Radiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masatoshi Hotta
- Division of Nuclear Medicine, Department of Radiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masahiro Ishikane
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takeshi Inagaki
- Department of General Internal Medicine, National Center for Global Health and Medicine, Tokyo, Japan
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24
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Fu C, Zhang W, Li H, Bai Y, Bae KT, Wang M, Xu J, Shao F. FDG PET/CT evaluation of a patient recovering from COVID-19. Eur J Nucl Med Mol Imaging 2020; 47:2703-2705. [PMID: 32671452 PMCID: PMC7363011 DOI: 10.1007/s00259-020-04958-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/08/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Chang Fu
- Department of Nuclear Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450003, Henan, China
| | - Weifeng Zhang
- Department of Nuclear Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450003, Henan, China
| | - Huiqiang Li
- Department of Nuclear Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450003, Henan, China
| | - Yan Bai
- Department of Radiology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450003, Henan, China
| | - Kyongtae Ty Bae
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA
| | - Meiyun Wang
- Department of Radiology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450003, Henan, China.
| | - Junling Xu
- Department of Nuclear Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450003, Henan, China.
| | - Fengmin Shao
- Department of Nephrology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450003, Henan, China
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25
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Jiang ZZ, He C, Wang DQ, Shen HL, Sun JL, Gan WN, Lu JY, Liu XT. The Role of Imaging Techniques in Management of COVID-19 in China: From Diagnosis to Monitoring and Follow-Up. Med Sci Monit 2020; 26:e924582. [PMID: 32653890 PMCID: PMC7375030 DOI: 10.12659/msm.924582] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/08/2020] [Indexed: 12/23/2022] Open
Abstract
In December 2019, an outbreak of coronavirus infection emerged in Wuhan, Hubei Province of China, which is now named Coronavirus Disease 2019 (COVID-19). The outbreak spread rapidly within mainland China and globally. This paper reviews the different imaging modalities used in the diagnosis and treatment process of COVID-19, such as chest radiography, computerized tomography (CT) scan, ultrasound examination, and positron emission tomography (PET/CT) scan. A chest radiograph is not recommended as a first-line imaging modality for COVID-19 infection due to its lack of sensitivity, especially in the early stages of infection. Chest CT imaging is reported to be a more reliable, rapid, and practical method for diagnosis of COVID-19, and it can assess the severity of the disease and follow up the disease time course. Ultrasound, on the other hand, is portable and involves no radiation, and thus can be used in critically ill patients to assess cardiorespiratory function, guide mechanical ventilation, and identify the presence of deep venous thrombosis and secondary pulmonary thromboembolism. Supplementary information can be provided by PET/CT. In the absence of vaccines and treatments for COVID-19, prompt diagnosis and appropriate treatment are essential. Therefore, it is important to exploit the advantages of different imaging modalities in the fight against COVID-19.
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Affiliation(s)
- Zhen-zhen Jiang
- Department of Ultrasound, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, Zhejiang, P.R. China
| | - Cong He
- Department of Radiology, Shaoxing Second Hospital, Shaoxing, Zhejiang, P.R. China
| | - De-qing Wang
- Department of Radiology, Shaoxing People’s Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, Zhejiang, P.R. China
| | - Hua-liang Shen
- Department of Ultrasound, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, Zhejiang, P.R. China
| | - Jia-li Sun
- Department of Ultrasound, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, Zhejiang, P.R. China
| | - Wan-ni Gan
- Department of Ultrasound, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, Zhejiang, P.R. China
| | - Jia-ying Lu
- Department of Ultrasound, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, Zhejiang, P.R. China
| | - Xia-tian Liu
- Department of Ultrasound, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, Zhejiang, P.R. China
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26
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Xie T, Chen X, Zaidi H. Age-dependent dose calculations for common PET radionuclides and brain radiotracers in nonhuman primate computational models. Med Phys 2020; 47:4465-4476. [PMID: 32542710 DOI: 10.1002/mp.14333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/20/2020] [Accepted: 06/04/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The combination of nonhuman primates (NHPs) with the state-of-the-art molecular imaging technologies allows for within-subject longitudinal research aiming at gaining new insights into human normal and disease conditions and provides an ideal foundation for future translational studies of new diagnostic tools, medical interventions, and therapies. However, radiation dose estimations for nonhuman primates from molecular imaging probes are lacking and are difficult to perform experimentally. The aim of this work is to construct age-dependent NHP computational model series to estimate the absorbed dose to NHP specimens in common molecular imaging procedures. MATERIALS AND METHODS A series of NHP models from baby to adult were constructed based on nonuniform rational B-spline surface (NURBS) representations. Particle transport was simulated using Monte Carlo calculations to estimate S-values from nine positron-emitting radionuclides and absorbed doses from PET radiotracers. RESULTS Realistic age-dependent NHP computational model series were developed. For most source-target pairs in computational NHP models, differences between C-11 S-values were between -13.4% and -8.8%/kg difference in body weight while differences between F-18 S-values were between -12.9% and -8.0%/kg difference in body weight. The absorbed doses of 11 C-labeled brain receptor substances, 18 F-labeled brain receptor substances, and 18 F-FDG in the brain ranged within 0.047-0.32 mGy/MBq, 0.25-1.63 mGy/MBq, and 0.32-2.12 mGy/MBq, respectively. CONCLUSION The absorbed doses to organs are significantly higher in the baby NHP model than in the adult model. These results can be used in translational longitudinal studies to estimate the cumulated absorbed organ doses in NHPs at various ages.
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Affiliation(s)
- Tianwu Xie
- Institute of Radiation Medicine, Fudan University, 2094 Xietu Road, Shanghai, 200032, China.,Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, CH-1211, Switzerland
| | - Xin Chen
- Institute of Radiation Medicine, Fudan University, 2094 Xietu Road, Shanghai, 200032, China
| | - Habib Zaidi
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, CH-1211, Switzerland.,Geneva Neuroscience Center, Geneva University, Geneva, CH-1205, Switzerland.,Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.,Department of Nuclear Medicine, University of Southern Denmark, Odense, DK-500, Denmark
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27
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Reed-Embleton H, Khan KS, Mathias N, Mahmud S. Case report: incidental findings of COVID-19 infection on positron emission tomography/computed tomography for staging of a giant gastric gastrointestinal stromal tumor. Pan Afr Med J 2020; 35:28. [PMID: 33623553 PMCID: PMC7875735 DOI: 10.11604/pamj.supp.2020.35.2.23167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 02/01/2023] Open
Abstract
We report the incidental finding of COVID-19 in a 59-year-old male, with no significant cardiorespiratory past medical history who underwent a fluorodeoxyglucose positron emission tomography (FDG-PET) scan for investigation of a likely gastric gastrointestinal stromal tumor (GIST). There may be significant discrepancies between clinical symptoms and radiological severity with COVID-19 infection. FDG-PET scanning has the potential to complement traditional radiological imaging in COVID-19 in diagnosis of subclinical diagnosis or early stage disease, as well as monitoring disease progression.
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Affiliation(s)
- Hamish Reed-Embleton
- Department of Surgery, University Hospital Hairmyres, East Kilbride, Scotland, UK
| | - Khurram Shahzad Khan
- Department of Surgery, University Hospital Hairmyres, East Kilbride, Scotland, UK
| | - Navin Mathias
- Department of Radiology, University Hospital Hairmyres, East Kilbride, Scotland, UK
| | - Sajid Mahmud
- Department of Surgery, University Hospital Hairmyres, East Kilbride, Scotland, UK
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28
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The potential added value of FDG PET/CT for COVID-19 pneumonia. Eur J Nucl Med Mol Imaging 2020; 47:1634-1635. [PMID: 32198615 PMCID: PMC7087529 DOI: 10.1007/s00259-020-04767-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/10/2020] [Indexed: 02/07/2023]
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29
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Qin C, Liu F, Yen TC, Lan X. 18F-FDG PET/CT findings of COVID-19: a series of four highly suspected cases. Eur J Nucl Med Mol Imaging 2020; 47:1281-1286. [PMID: 32088847 PMCID: PMC7080035 DOI: 10.1007/s00259-020-04734-w] [Citation(s) in RCA: 200] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/17/2020] [Indexed: 12/13/2022]
Abstract
Purpose The aim of this case series is to illustrate the 18F-FDG PET/CT findings of patients with acute respiratory disease caused by COVID-19 in Wuhan, Hubei province of China. Methods We describe the 18F-FDG PET/CT results from four patients who were admitted to the hospital with respiratory symptoms and fever between January 13 and January 20, 2020, when the COVID-19 outbreak was still unrecognized and the virus infectivity was unknown. A retrospective review of the patients’ medical history, clinical and laboratory data, as well as imaging findings strongly suggested a diagnosis of COVID-19. Results All patients had peripheral ground-glass opacities and/or lung consolidations in more than two pulmonary lobes. Lung lesions were characterized by a high 18F-FDG uptake and there was evidence of lymph node involvement. Conversely, disseminated disease was absent, a finding suggesting that COVID-19 has pulmonary tropism. Conclusions Although 18F-FDG PET/CT cannot be routinely used in an emergency setting and is generally not recommended for infectious diseases, our pilot data shed light on the potential clinical utility of this imaging technique in the differential diagnosis of complex cases.
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Affiliation(s)
- Chunxia Qin
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Fang Liu
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Tzu-Chen Yen
- Department of Nuclear Medicine and Molecular Imaging Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
| | - Xiaoli Lan
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, China. .,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
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30
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Dyall J, Johnson RF, Chefer S, Leyson C, Thomasson D, Seidel J, Ragland DR, Byrum R, Jett C, Cann JA, St Claire M, Jagoda E, Reba RC, Hammoud D, Blaney JE, Jahrling PB. [ 18F]-Fluorodeoxyglucose Uptake in Lymphoid Tissue Serves as a Predictor of Disease Outcome in the Nonhuman Primate Model of Monkeypox Virus Infection. J Virol 2017; 91:e00897-17. [PMID: 28814515 PMCID: PMC5640857 DOI: 10.1128/jvi.00897-17] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 07/14/2017] [Indexed: 11/20/2022] Open
Abstract
Real-time bioimaging of infectious disease processes may aid countermeasure development and lead to an improved understanding of pathogenesis. However, few studies have identified biomarkers for monitoring infections using in vivo imaging. Previously, we demonstrated that positron emission tomography/computed tomography (PET/CT) imaging with [18F]-fluorodeoxyglucose (FDG) can monitor monkeypox disease progression in vivo in nonhuman primates (NHPs). In this study, we investigated [18F]-FDG-PET/CT imaging of immune processes in lymphoid tissues to identify patterns of inflammation in the monkepox NHP model and to determine the value of [18F]-FDG-PET/CT as a biomarker for disease and treatment outcomes. Quantitative analysis of [18F]-FDG-PET/CT images revealed differences between moribund and surviving animals at two sites vital to the immune response to viral infections, bone marrow and lymph nodes (LNs). Moribund NHPs demonstrated increased [18F]-FDG uptake in bone marrow 4 days postinfection compared to surviving NHPs. In surviving, treated NHPs, increase in LN volume correlated with [18F]-FDG uptake and peaked 10 days postinfection, while minimal lymphadenopathy and higher glycolytic activity were observed in moribund NHPs early in infection. Imaging data were supported by standard virology, pathology, and immunology findings. Even with the limited number of subjects, imaging was able to differentiate the difference between disease outcomes, warranting additional studies to demonstrate whether [18F]-FDG-PET/CT can identify other, subtler effects. Visualizing altered metabolic activity at sites involved in the immune response by [18F]-FDG-PET/CT imaging is a powerful tool for identifying key disease-specific time points and locations that are most relevant for pathogenesis and treatment.IMPORTANCE Positron emission tomography and computed tomography (PET/CT) imaging is a universal tool in oncology and neuroscience. The application of this technology to infectious diseases is far less developed. We used PET/CT imaging with [18F]-labeled fluorodeoxyglucose ([18F]-FDG) in monkeys after monkeypox virus exposure to monitor the immune response in lymphoid tissues. In lymph nodes of surviving monkeys, changes in [18F]-FDG uptake positively correlated with enlargement of the lymph nodes and peaked on day 10 postinfection. In contrast, the bone marrow and lymph nodes of nonsurvivors showed increased [18F]-FDG uptake by day 4 postinfection with minimal lymph node enlargement, indicating that elevated cell metabolic activity early after infection is predictive of disease outcome. [18F]-FDG-PET/CT imaging can provide real-time snapshots of metabolic activity changes in response to viral infections and identify key time points and locations most relevant for monitoring the development of pathogenesis and for potential treatment to be effective.
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Affiliation(s)
- Julie Dyall
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland, USA
| | - Reed F Johnson
- Emerging Viral Pathogens Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland, USA
| | - Svetlana Chefer
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland, USA
| | - Christopher Leyson
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland, USA
| | - David Thomasson
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland, USA
| | - Jurgen Seidel
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland, USA
| | - Dan R Ragland
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland, USA
| | - Russell Byrum
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland, USA
| | - Catherine Jett
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland, USA
| | - Jennifer A Cann
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland, USA
| | - Marisa St Claire
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland, USA
| | - Elaine Jagoda
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Richard C Reba
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland, USA
- Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Dima Hammoud
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland, USA
- Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Joseph E Blaney
- Emerging Viral Pathogens Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland, USA
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Peter B Jahrling
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland, USA
- Emerging Viral Pathogens Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland, USA
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Kinetic Modelling of Infection Tracers [ 18F]FDG, [ 68Ga]Ga-Citrate, [ 11C]Methionine, and [ 11C]Donepezil in a Porcine Osteomyelitis Model. CONTRAST MEDIA & MOLECULAR IMAGING 2017; 2017:9256858. [PMID: 29114181 PMCID: PMC5654273 DOI: 10.1155/2017/9256858] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 08/24/2017] [Indexed: 12/28/2022]
Abstract
Introduction Positron emission tomography (PET) is increasingly applied for infection imaging using [18F]FDG as tracer, but uptake is unspecific. The present study compares the kinetics of [18F]FDG and three other PET tracers with relevance for infection imaging. Methods A juvenile porcine osteomyelitis model was used. Eleven pigs underwent PET/CT with 60-minute dynamic PET imaging of [18F]FDG, [68Ga]Ga-citrate, [11C]methionine, and/or [11C]donepezil, along with blood sampling. For infectious lesions, kinetic modelling with one- and two-tissue-compartment models was conducted for each tracer. Results Irreversible uptake was found for [18F]FDG and [68Ga]Ga-citrate; reversible uptake was found for [11C]methionine (two-tissue model) and [11C]donepezil (one-tissue model). The uptake rate for [68Ga]Ga-citrate was slow and diffusion-limited. For the other tracers, the uptake rate was primarily determined by perfusion (flow-limited uptake). Net uptake rate for [18F]FDG and distribution volume for [11C]methionine were significantly higher for infectious lesions than for correspondingly noninfected tissue. For [11C]donepezil in pigs, labelled metabolite products appeared to be important for the analysis. Conclusions The kinetics of the four studied tracers in infection was characterized. For clinical applications, [18F]FDG remains the first-choice PET tracer. [11C]methionine may have a potential for detecting soft tissue infections. [68Ga]Ga-citrate and [11C]donepezil were not found useful for imaging of osteomyelitis.
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