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1.
J Med Virol ; 94(5): 1833-1845, 2022 05.
Article in English | MEDLINE | ID: covidwho-1777585

ABSTRACT

Coronavirus disease 2019 (COVID-19) has caused a global pandemic that continues to cause numerous deaths to date. Four vaccines have been approved by the Food and Drug Administration as of July 2021 to prevent the transmission of COVID-19: Pfizer, Moderna, AstraZeneca, and Janssen. These vaccines have shown great efficacy and safety profile. One side effect that has been widely reported is post-COVID-19 vaccination lymphadenopathy. Due to the mimicry of the lymphadenopathy for metastases in some oncologic patients, there have been reports of patients who underwent biopsies that showed pathologic confirmation of benign reactive lymphadenopathy secondary to the COVID-19 vaccine. Therefore, understanding the incidence of lymphadenopathy post-COVID-19 vaccinations will help guide radiologists and oncologists in their management of patients, both present oncologic patients, and patients with concerns over their newly presenting lymphadenopathy. A systematic literature search was performed using several databases to identify relevant studies that reported lymphadenopathy post-COVID-19 vaccination. Our results revealed that several cases have been detected in patients undergoing follow-up fluorodeoxyglucose (FDG)-positron emission tomography-computerized tomography scans where lymph nodes ipsilateral to the vaccine injection site show increased uptake of FDG. Thus, knowledge of the incidence of lymphadenopathy may help avoid unnecessary biopsies, interventions, and changes in management for patients, especially oncologic patients who are at risk for malignancies.


Subject(s)
COVID-19 , Lymphadenopathy , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Fluorodeoxyglucose F18 , Humans , Lymphadenopathy/diagnostic imaging , Lymphadenopathy/etiology , Positron Emission Tomography Computed Tomography/adverse effects , Positron Emission Tomography Computed Tomography/methods , SARS-CoV-2 , United States , Vaccination/adverse effects
2.
J Nucl Med ; 63(2): 270-273, 2022 02.
Article in English | MEDLINE | ID: covidwho-1753320

ABSTRACT

The aim of this study was to assess the temporal evolution of pulmonary 18F-FDG uptake in patients with coronavirus disease 2019 (COVID-19) and post-COVID-19 lung disease (PCLD). Methods: Using our hospital's clinical electronic records, we retrospectively identified 23 acute COVID-19, 18 PCLD, and 9 completely recovered 18F-FDG PET/CT patients during the 2 peaks of the U.K. pandemic. Pulmonary 18F-FDG uptake was measured as a lung target-to-background ratio (TBRlung = SUVmax/SUVmin) and compared with temporal stage. Results: In acute COVID-19, less than 3 wk after infection, TBRlung was strongly correlated with time after infection (r s = 0.81, P < 0.001) and was significantly higher in the late stage than in the early stage (P = 0.001). In PCLD, TBRlung was lower in patients treated with high-dose steroids (P = 0.003) and in asymptomatic patients (P < 0.001). Conclusion: Pulmonary 18F-FDG uptake in COVID-19 increases with time after infection. In PCLD, pulmonary 18F-FDG uptake rises despite viral clearance, suggesting ongoing inflammation. There was lower pulmonary 18F-FDG uptake in PCLD patients treated with steroids.


Subject(s)
COVID-19/diagnostic imaging , Fluorodeoxyglucose F18/pharmacokinetics , Lung/diagnostic imaging , Positron Emission Tomography Computed Tomography/methods , Radiopharmaceuticals/pharmacokinetics , SARS-CoV-2 , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Retrospective Studies , Young Adult
3.
Brain Behav ; 12(4): e2513, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1739128

ABSTRACT

OBJECTIVE: To assess FDG cerebral PET in patients suffering from cognitive impairment linked to Long COVID. The COVID pandemic has affected dozens of millions of people around the world and has resulted in the deaths of more than 3 million people. Following the acute forms, it has been reported sometimes long forms of COVID, with involvements of several organs including the brain. Neurological complications can include cognitive disturbances (brain fog) that are very common and can seriously disturb the life of patients. METHODS: Fluorodeoxyglucose PETs were performed in 3 patients with cognitive decline following COVID infection. RESULTS: We report here 3 cases of brain fog with major hypometabolic areas of the pons revealed by the cerebral FDG PET. CONCLUSION: The dysfunction of the locus coeruleus in these patients could partly explain the cognitive disorders observed. Further studies involving larger cohorts of patients suffering from cognitive dysfunction will be needed to determine if the brainstem is frequently affected in these patients.


Subject(s)
COVID-19 , Cognitive Dysfunction , Brain/diagnostic imaging , Brain Stem/diagnostic imaging , COVID-19/complications , COVID-19/diagnostic imaging , Cognitive Dysfunction/diagnostic imaging , Cognitive Dysfunction/etiology , Fluorodeoxyglucose F18 , Humans , Positron-Emission Tomography , Radiopharmaceuticals
4.
Clin Nucl Med ; 47(5): e421-e422, 2022 May 01.
Article in English | MEDLINE | ID: covidwho-1722749

ABSTRACT

ABSTRACT: A 22-year-old man visited the emergency department with chest pain. He had received a second dose of the coronavirus disease 2019 (COVID-19) mRNA (Moderna) vaccine 5 days prior. 18F-FDG PET/MR revealed a focal FDG uptake and late gadolinium enhancement on the basal posterolateral wall of the left ventricle. Myocarditis after a COVID-19 vaccination has been reported predominantly after the second dose of mRNA vaccines in young men. This was a case of acute focal myocarditis after a COVID-19 mRNA vaccination, which was well-visualized by FDG PET/MRI.


Subject(s)
COVID-19 , Myocarditis , Adult , COVID-19 Vaccines/adverse effects , Contrast Media , Fluorodeoxyglucose F18 , Gadolinium , Humans , Magnetic Resonance Imaging , Male , Myocarditis/diagnostic imaging , Myocarditis/etiology , RNA, Messenger , Vaccination , Young Adult
5.
PET Clin ; 17(2): 213-222, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1719570

ABSTRACT

Head and neck squamous cell carcinoma (HNSCC) imaging is nearly synonymous with positron emission tomography (PET) scans. Many of the nearly 60,000 newly diagnosed patients with HNSCC in the US-and 900,000 worldwide-will undergo a PET scan, if not multiple, throughout the course of their care. In this review, we describe the clinical utility of PET scans in HNSCC, emphasizing whereby their input is most impactful in improving patient outcomes as well as scenarios whereby PET/CT scans should be avoided. We also describe important considerations for capturing and processing PET scans with a special focus on the important role of tumor volume segmentation, scan timing relative to therapy, and concurrent conditions (eg, COVID-19). In addition, we will illustrate the latest innovations in the management of HNSCC. This article also will delve to exhibit novel potential biomarkers in the management of HNSCC. Finally, we describe future directions for PET imaging, including the advent of novel PET radiotracers as an alternative to 18F-fluorodeoxyglucose (18F-FDG).


Subject(s)
COVID-19 , Carcinoma, Squamous Cell , Head and Neck Neoplasms , COVID-19/diagnostic imaging , Carcinoma, Squamous Cell/diagnostic imaging , Fluorodeoxyglucose F18 , Head and Neck Neoplasms/diagnostic imaging , Humans , Positron Emission Tomography Computed Tomography/methods , Positron-Emission Tomography/methods , Radiopharmaceuticals , Squamous Cell Carcinoma of Head and Neck/diagnostic imaging
6.
Clin Nucl Med ; 47(3): e327-e328, 2022 Mar 01.
Article in English | MEDLINE | ID: covidwho-1691728

ABSTRACT

ABSTRACT: A 46-year-old woman with previous history of breast cancer had follow-up 18F-FDG PET/CT 5 days after COVID-19 vaccination. In addition to avid axillary nodes, a well-documented feature, the scan demonstrated diffuse splenic and marrow uptake. Clinical history, laboratory, and scan findings were in keeping with SIRS (systemic inflammatory response). The patient recovered with supportive management. On follow-up, 18F-FDG PET/CT imaging 3 months later features had resolved. SIRS after vaccination may be observed on 18F-FDG PET/CT.


Subject(s)
COVID-19 , Fluorodeoxyglucose F18 , COVID-19 Vaccines , Female , Follow-Up Studies , Humans , Immunity , Middle Aged , Positron Emission Tomography Computed Tomography , Positron-Emission Tomography , SARS-CoV-2 , Vaccination
7.
Clin Nucl Med ; 47(5): e397-e398, 2022 May 01.
Article in English | MEDLINE | ID: covidwho-1691726

ABSTRACT

ABSTRACT: Of the various adverse reactions to COVID-19 vaccines, fever is a common systemic symptom that often resolves spontaneously without treatment. However, rare vaccine-induced conditions that present with fever and systemic inflammation have been reported. In this case, a 65-year-old man with BNT162b2 mRNA COVID-19 vaccination underwent 18F-FDG PET/CT to evaluate prolonged fever and elevated serum C-reactive protein. PET/CT showed hypermetabolic infiltration in the pericardium and peritoneum suggesting immune-mediated pericarditis and peritonitis. After administration of high-dose corticosteroids, the patient's symptom resolved. This case suggests that multisystem inflammatory syndrome and polyserositis can be induced by the COVID-19 vaccine.


Subject(s)
COVID-19 Vaccines , COVID-19 , Aged , COVID-19/complications , COVID-19 Vaccines/adverse effects , Fluorodeoxyglucose F18 , Humans , Inflammation , Male , Positron Emission Tomography Computed Tomography , SARS-CoV-2
8.
Clin Nucl Med ; 47(5): e403-e405, 2022 May 01.
Article in English | MEDLINE | ID: covidwho-1691725

ABSTRACT

ABSTRACT: Causality regarding adverse events following SARS-CoV-2 mRNA vaccine is undetermined for vasculitis. Herein, we report the case of an 80-year-old man who presented with a persistent high fever of 7 days' duration that began shortly after receiving a COVID-19 vaccination. There was also a complaint of persistent lower limb pain and walking difficulty on emergency transportation. FDG PET/CT demonstrated extensive linear hypermetabolic foci along the vessels of both legs, including the hips, and the arms, supraclavicular area, chest wall, and temporal regions, suggesting systemic vasculitis. Subsequent temporal artery biopsy revealed arteritis, which is not typical of giant cell arteritis.


Subject(s)
COVID-19 , Giant Cell Arteritis , Systemic Vasculitis , Aged, 80 and over , COVID-19 Vaccines/adverse effects , Fluorodeoxyglucose F18 , Humans , Male , Positron Emission Tomography Computed Tomography , RNA, Messenger , SARS-CoV-2 , Vaccination , Vaccines, Synthetic
9.
Curr Oncol ; 29(2): 989-1000, 2022 02 10.
Article in English | MEDLINE | ID: covidwho-1686627

ABSTRACT

In the following report, we describe 11 patients with various diagnoses and different treatment statuses (newly diagnosed, receiving treatment, or follow-up) of oncological diseases (breast, lymphoma, melanoma, and head and neck cancers). The patients underwent PET-CT for disease staging or follow-up and it was noted that all patients had areas of hypermetabolic uptake in the axillary lymph-nodes of the ipsilateral upper extremity where the Pfizer-BioNTech coronavirus (COVID-19) vaccine was administered. Following further investigations, including an ultrasound (US), biopsies and an examination of medical records, it was concluded that these findings were the result of the vaccination and not a progression of pre-existing disease.


Subject(s)
COVID-19 , Fluorodeoxyglucose F18 , COVID-19 Vaccines , Humans , Positron Emission Tomography Computed Tomography , Positron-Emission Tomography , SARS-CoV-2 , Vaccination
10.
Clin Nucl Med ; 47(2): e123-e124, 2022 Feb 01.
Article in English | MEDLINE | ID: covidwho-1684922

ABSTRACT

ABSTRACT: Recently, vaccination against COVID-19 has gained wide diffusion, especially among vulnerable individuals, such as cancer patients. At the same time, patients have been undergoing PET/CT examinations after vaccination in an increasing number, and cases of false-positive axillary nodal uptake have been described, mostly at 18F-FDG PET. Here, we describe the case of both 68Ga-DOTATOC and 18F-FDG axillary nodal uptake in a young woman affected by a metastatic retroperitoneal paraganglioma.


Subject(s)
COVID-19 , Fluorodeoxyglucose F18 , COVID-19 Vaccines , Female , Humans , Octreotide/analogs & derivatives , Organometallic Compounds , Positron Emission Tomography Computed Tomography , SARS-CoV-2
11.
Clin Nucl Med ; 47(2): 195-196, 2022 Feb 01.
Article in English | MEDLINE | ID: covidwho-1684921

ABSTRACT

ABSTRACT: COVID-19 vaccination has started in most countries, and postvaccination imaging is inevitable in the oncologic population. The immune response to the vaccination in the form of reactive lymphadenopathy has been well documented on 18F-FDG PET/CT. We present the imaging findings of 3 patients who have undergone non-FDG PET/CT imaging including 18F-fluorthanatrace, 68Ga-DOTATATE, and 18F-fluciclovine PET/CT. It is crucial to recognize the timing and laterality of immunization to avoid false-positive findings.


Subject(s)
COVID-19 , Lymphadenopathy , COVID-19 Vaccines , Fluorodeoxyglucose F18 , Humans , Positron Emission Tomography Computed Tomography , Positron-Emission Tomography , Radionuclide Imaging , SARS-CoV-2 , Vaccination
12.
Clin Nucl Med ; 47(2): e177-e179, 2022 Feb 01.
Article in English | MEDLINE | ID: covidwho-1684920

ABSTRACT

ABSTRACT: Occurrence of invasive fungal infections has gained significant attention during recent times in patients with COVID-19. Patients with severe form of COVID-19, such as those treated in the intensive care unit with prolonged steroid use, are particularly vulnerable to secondary bacterial and fungal infections. Disseminated systemic mycosis is a life-threatening condition, especially in immunocompromised patients. Here, we report a case of a recovered severe COVID-19 patient, who presented with persistent fever. 18F-FDG-labeled leukocyte scan revealed focal accumulation of radiotracer in the small intestine and right lung lower lobe. Subsequently, performed biopsy revealed mucormycosis.


Subject(s)
COVID-19 , Invasive Fungal Infections , Fluorodeoxyglucose F18 , Humans , Leukocytes , Positron Emission Tomography Computed Tomography , SARS-CoV-2
13.
J Pak Med Assoc ; 71(12): 2834, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1679127

ABSTRACT

Corona virus disease 2019 (COVID-19), originated from Wuhan province of China, is responsible for causing severe respiratory syndrome (SARS-Cov-2). Initial specific investigation to diagnose the viral infection includes nasopharyngeal nucleic acid testing (RT-PCR). However other modalities can also aid in detection of COVID-19 infection. For instance, COVID pneumonitis related findings on positron emission tomography (PET/CT) scan acquired, during routine evaluation; can help in detection the viral infection in asymptomatic patients thereby preventing further spread of infection to other patients, physicians; and family members. This can alert physicians in taking prophylactic and preventive measures for management of these asymptomatic patient.


Subject(s)
COVID-19 , Pneumonia , Fluorodeoxyglucose F18 , Humans , Positron Emission Tomography Computed Tomography , Radiopharmaceuticals , SARS-CoV-2
15.
J Nucl Med ; 63(2): 270-273, 2022 02.
Article in English | MEDLINE | ID: covidwho-1674256

ABSTRACT

The aim of this study was to assess the temporal evolution of pulmonary 18F-FDG uptake in patients with coronavirus disease 2019 (COVID-19) and post-COVID-19 lung disease (PCLD). Methods: Using our hospital's clinical electronic records, we retrospectively identified 23 acute COVID-19, 18 PCLD, and 9 completely recovered 18F-FDG PET/CT patients during the 2 peaks of the U.K. pandemic. Pulmonary 18F-FDG uptake was measured as a lung target-to-background ratio (TBRlung = SUVmax/SUVmin) and compared with temporal stage. Results: In acute COVID-19, less than 3 wk after infection, TBRlung was strongly correlated with time after infection (r s = 0.81, P < 0.001) and was significantly higher in the late stage than in the early stage (P = 0.001). In PCLD, TBRlung was lower in patients treated with high-dose steroids (P = 0.003) and in asymptomatic patients (P < 0.001). Conclusion: Pulmonary 18F-FDG uptake in COVID-19 increases with time after infection. In PCLD, pulmonary 18F-FDG uptake rises despite viral clearance, suggesting ongoing inflammation. There was lower pulmonary 18F-FDG uptake in PCLD patients treated with steroids.


Subject(s)
COVID-19/diagnostic imaging , Fluorodeoxyglucose F18/pharmacokinetics , Lung/diagnostic imaging , Positron Emission Tomography Computed Tomography/methods , Radiopharmaceuticals/pharmacokinetics , SARS-CoV-2 , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Retrospective Studies , Young Adult
16.
J Nucl Med ; 63(2): 274-279, 2022 02.
Article in English | MEDLINE | ID: covidwho-1674255

ABSTRACT

Although the novel coronavirus disease 2019 (COVID-19) can present as nonspecific clinical forms, subclinical cases represent an important route of transmission and a significant source of mortality, mainly in high-risk subpopulations such as cancer patients. A deeper knowledge of the metabolic shift in cells infected with severe acute respiratory syndrome coronavirus 2 could provide new insights about its pathogenic and host response and help to diagnose pulmonary involvement. We explored the potential added diagnostic value of 18F-FDG PET/CT scans in asymptomatic cancer patients with suspected COVID-19 pneumonia by investigating the association between metabolic and structural changes in the lung parenchyma. Methods: 18F-FDG PET/CT studies acquired between February 19 and May 29, 2020, were reviewed to identify those cancer patients with incidental findings suggestive of COVID-19 pneumonia. PET studies were interpreted through qualitative (visual) and semiquantitative (measurement of SUVmax) analysis evaluating lung findings. Several characteristic signs of COVID-19 pneumonia on CT were described as COVID-19 Reporting and Data System (CO-RADS) categories (1-6). After comparing the SUVmax of pulmonary infiltrates among different CO-RADS categories, we explored the best potential cutoffs for pulmonary SUVmax against CO-RADS categories as the gold standard result to eliminate the possibility that the diagnosis of COVID-19 pneumonia exists. Results: On multimodal PET/CT imaging, CT signs classified as CO-RADS category 5 or 6 were found in 16 of 41 (39%) oncologic patients. SUVmax was higher in patients with categories 5 and 6 than in patients with category 4 (6.17 ± 0.82 vs. 3.78 ± 0.50, P = 0.04) or categories 2 and 3 (3.59 ± 0.41, P = 0.01). A specificity of 93.8% (95% CI, 71.7%-99.7%) and an accuracy of 92.9% were obtained when combining a CO-RADS score of 5 or 6 with an SUVmax of 2.45 in pulmonary infiltrates. Conclusion: In asymptomatic cancer patients, the metabolic activity in lung infiltrates is closely associated with several combined tomographic changes characteristic of COVID-19 pneumonia. Multimodal 18F-FDG PET/CT imaging could provide additional information during early diagnosis in selected predisposed patients during the pandemic. The prognostic implications of simultaneous radiologic and molecular findings in cancer patients and other subpopulations at high risk for COVID-19 pneumonia deserve further evaluation in prospective research.


Subject(s)
COVID-19/diagnostic imaging , Fluorodeoxyglucose F18 , Lung/diagnostic imaging , Neoplasms/diagnostic imaging , Positron Emission Tomography Computed Tomography/methods , Radiopharmaceuticals , SARS-CoV-2 , Aged , Aged, 80 and over , Female , Humans , Lung/metabolism , Lung/pathology , Male , Middle Aged , Neoplasms/metabolism , Neoplasms/pathology
17.
Clin Nucl Med ; 47(4): e363-e365, 2022 Apr 01.
Article in English | MEDLINE | ID: covidwho-1672451

ABSTRACT

ABSTRACT: SARS-CoV-2 is primarily known to cause respiratory symptoms. However, in this global COVID-19 pandemic, we have come across many extrapulmonary manifestations during and in the immediate post-COVID phase such as gastrointestinal symptoms, kidney and liver injury, myocardial dysfunction and acute coronary syndromes, and neurological, thromboembolic, dermatological, and musculoskeletal disorders. We present 2 such unusual cases of post-COVID complications-diffuse panniculitis and inflammatory myositis, as well as their clinical and FDG PET/CT imaging features.


Subject(s)
COVID-19 , Fluorodeoxyglucose F18 , Humans , Pandemics , Positron Emission Tomography Computed Tomography , SARS-CoV-2
18.
Clin Nucl Med ; 47(3): 275-276, 2022 Mar 01.
Article in English | MEDLINE | ID: covidwho-1672448

ABSTRACT

ABSTRACT: Since worldwide COVID-19 vaccination, 18F-FDG uptake in reactive axillary lymph nodes has been frequently observed in PET/CT studies. We describe a patient with breast cancer who underwent 18F-FDG PET/CT 7 days after receiving COVID-19 vaccination in the right thigh. 18F-FDG uptake was observed in nonenlarged right-sided inguinal, iliac, and para-aortic lymph nodes. As the thigh can be used as an alternate site for COVID-19 vaccine injection in case of lymphedema in both arms or for adequate axillary staging in patients with breast cancer, physicians should be aware of such 18F-FDG uptake pattern.


Subject(s)
COVID-19 Vaccines , COVID-19 , Fluorodeoxyglucose F18 , Humans , Lymph Nodes/diagnostic imaging , Positron Emission Tomography Computed Tomography , SARS-CoV-2 , Thigh/diagnostic imaging , Vaccination
19.
Ann Nucl Med ; 36(4): 340-350, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1661736

ABSTRACT

PURPOSE: Reactive FDG uptake in the axillary lymph nodes (ALN) and deltoid muscle (DM) after COVID-19 mRNA vaccination has been recognized, although the actual situation in the Japanese population remains unknown. To determine the incidence of reactive FDG uptake and its contributing factors, we retrospectively studied a cohort of subjects who were vaccinated at our hospital. METHODS: Whole-body FDG-PET/CT examinations performed in 237 subjects out of 240 subjects with a definite history of COVID-19 vaccination (BNT162b2; BioNTech-Pfizer) were analyzed. Positivity and SUVmax of FDG uptake in the ALN and DM ipsilateral to vaccination, various subject characteristics, and the grade of the pathological FDG-PET/CT findings were evaluated using a multivariate analysis. RESULTS: FDG uptake in the ALN and DM ipsilateral to vaccination was seen in about 60% of the subjects even soon (0-4 days) after the first vaccination, with percentages reaching 87.5% and 75.0%, respectively, after the second vaccination. DM uptake had almost disappeared at around 2 weeks, while ALN uptake persisted for 3 weeks or longer. A multivariate analysis showed that a short duration since vaccination, a younger age, a female sex, and a low FDG-PET/CT grade (minimal pathological FDG uptake) contributed significantly to positive ALN uptake, while a short duration since vaccination and a female sex were the only significant contributors to positive DM uptake. This study is the first to identify factors contributing to positive FDG uptake in ALN and DM after COVID-19 vaccination. CONCLUSION: A high incidence of FDG uptake in ALN and DM was observed after vaccination. ALN uptake seemed to be associated with a younger age, a female sex, and minimal pathological FDG uptake. After vaccination, an acute inflammatory reaction in DM followed by immune reaction in ALN linked to humoral immunity may be speculated.


Subject(s)
Breast Neoplasms , COVID-19 , COVID-19/prevention & control , COVID-19 Vaccines , Cohort Studies , Deltoid Muscle , Female , Fluorodeoxyglucose F18 , Humans , Incidence , Lymph Nodes , Multivariate Analysis , Positron Emission Tomography Computed Tomography , RNA, Messenger , Retrospective Studies , Vaccination
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