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2.
AJR Am J Roentgenol ; 217(3): 527-528, 2021 09.
Article in English | MEDLINE | ID: covidwho-1403390
3.
Emerg Radiol ; 28(6): 1073-1081, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1397017

ABSTRACT

PURPOSE: To analyze emergency department (ED) computerized tomography (CT) utilization in cancer patients with coronavirus disease 2019 (COVID-19). METHODS: A retrospective chart review was performed to identify cancer patients who received COVID-19 diagnosis within the single healthcare system and presented to the ED within 30 days of COVID-19 positive date between May 1 and December 31, 2020. RESULTS: In our 61 patients, the mean age was 72.5 years old, with 34% of patients (n = 21) on active cancer therapy and 66% (n = 40) on surveillance only. Most patients (n = 53) received their COVID-19 diagnosis within the ED, with 8 patients diagnosed prior to initial ED visit. The most common CT studies ordered within the ED were CT chest (n = 25), CT abdomen/pelvis (A/P) (n = 20), CT head (n = 8), and CT chest/abdomen/pelvis (C/A/P) (n = 7). COVID-19 findings were present on 33 scans, findings of worsening malignancy on 12 scans, and non-COVID non-cancer findings on 9 scans. Significant differences in CT severity score (p = 0.0001), indication for hospitalization (p = 0.026), length of hospitalization (p = 0.004), interventions (remdesivir, mechanical ventilation, and vasopressor support) while hospitalized (p < 0.05), and mortality (p = 0.042) were found between the prior diagnosis and ED diagnosis groups. No such differences were found between the active treatment and surveillance groups. CONCLUSION: ED CT imaging findings in patients with cancer and COVID-19 are predominantly related to COVID-19 infection, rather than cancer history or anti-cancer therapy status.


Subject(s)
COVID-19 , Neoplasms , Aged , COVID-19 Testing , Emergency Service, Hospital , Humans , Neoplasms/diagnostic imaging , Retrospective Studies , SARS-CoV-2 , Tomography, X-Ray Computed
4.
Cancer Med ; 10(18): 6327-6335, 2021 09.
Article in English | MEDLINE | ID: covidwho-1344970

ABSTRACT

BACKGROUND: We aimed to investigate the effects of COVID-19 on computed tomography (CT) imaging of cancer. METHODS: Cancer-related CTs performed at one academic hospital and three affiliated community hospitals in Massachusetts were retrospectively analyzed. Three periods of 2020 were considered as follows: pre-COVID-19 (1/5/20-3/14/20), COVID-19 peak (3/15/20-5/2/20), and post-COVID-19 peak (5/3/20-11/14/20). 15 March 2020 was the day a state of emergency was declared in MA; 3 May 2020 was the day our hospitals resumed to non-urgent imaging. The volumes were assessed by (1) Imaging indication: cancer screening, initial workup, active cancer, and surveillance; (2) Care setting: outpatient and inpatient, ED; (3) Hospital type: quaternary academic center (QAC), university-affiliated community hospital (UACH), and sole community hospitals (SCHs). RESULTS: During the COVID-19 peak, a significant drop in CT volumes was observed (-42.2%, p < 0.0001), with cancer screening, initial workup, active cancer, and cancer surveillance declining by 81.7%, 54.8%, 30.7%, and 44.7%, respectively (p < 0.0001). In the post-COVID-19 peak period, cancer screening and initial workup CTs did not recover (-11.7%, p = 0.037; -20.0%, p = 0.031), especially in the outpatient setting. CT volumes for active cancer recovered, but inconsistently across hospital types: the QAC experienced a 9.4% decline (p = 0.022) and the UACH a 41.5% increase (p < 0.001). Outpatient CTs recovered after the COVID-19 peak, but with a shift in utilization away from the QAC (-8.7%, p = 0.020) toward the UACH (+13.3%, p = 0.013). Inpatient and ED-based oncologic CTs increased post-peak (+20.0%, p = 0.004 and +33.2%, p = 0.009, respectively). CONCLUSIONS: Cancer imaging was severely impacted during the COVID-19 pandemic. CTs for cancer screening and initial workup did not recover to pre-COVID-19 levels well into 2020, a finding that suggests more patients with advanced cancers may present in the future. A redistribution of imaging utilization away from the QAC and outpatient settings, toward the community hospitals and inpatient setting/ED was observed.


Subject(s)
COVID-19/epidemiology , Neoplasms/diagnostic imaging , Pandemics/statistics & numerical data , Emergency Service, Hospital/statistics & numerical data , Hospitals , Humans , Inpatients/statistics & numerical data , Massachusetts/epidemiology , Outpatients/statistics & numerical data , Retrospective Studies , SARS-CoV-2/pathogenicity , Tomography, X-Ray Computed/methods
6.
Cancer Treat Rev ; 98: 102220, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1275253

ABSTRACT

As the world embarks on mass vaccination for COVID-19, we are beginning to encounter unintended dilemmas in imaging oncology patients; particularly with regards to FDG PET/CT. In some cases, vaccine-related lymphadenopathy and FDG uptake on PET/CT can mimic cancer and lead to confounding imaging results. These cases where findings overlap with cancer pose a significant dilemma for diagnostic purposes, follow-up, and management leading to possible treatment delays, unnecessary repeat imaging and sampling, and patient anxiety. These cases can largely be avoided by optimal coordination between vaccination and planned imaging as well as preemptive selection of vaccine administration site. This coordination hinges on patient, oncologist, and radiologists' awareness of this issue and collaboration. Through close communication and patient education, we believe this will eliminate significant challenges for our oncology patients as we strive to end this pandemic.


Subject(s)
COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Lymphadenopathy/diagnosis , Neoplasms/diagnosis , Positron Emission Tomography Computed Tomography/standards , Vaccination/adverse effects , COVID-19/virology , Diagnosis, Differential , Disease Progression , Fluorodeoxyglucose F18/metabolism , Humans , Lymphadenopathy/chemically induced , Lymphadenopathy/diagnostic imaging , Neoplasms/chemically induced , Neoplasms/diagnostic imaging , Radiopharmaceuticals/metabolism , SARS-CoV-2/isolation & purification
8.
Indian J Cancer ; 58(2): 248-258, 2021.
Article in English | MEDLINE | ID: covidwho-1261388

ABSTRACT

Background: Coronavirus disease-2019 (COVID-19) causing a pandemic mostly results in mild symptoms; however, it can evolve into serious complications. It is emphasized that if the term from the recent anticancer treatment to the diagnosis of COVID-19 was short, the probability of serious events increased in cancer patients. Therefore, early detection of COVID-19 and prevention of serious events is very important. We aimed to investigate whether it is possible to detect COVID-19 early by positron emission tomography (PET)/computed tomography (CT). Methods: We retrospectively evaluated the images and clinical findings of patients who underwent PET/CT due to malignancy and whose COVID-19 polymerase chain reaction (PCR) test were detected positive subsequently. Results: Eight cancer patients with positive COVID-19 PCR tests were included in the study. PET/CT revealed subpleural ground-glass opacities (GGOs) showing mild fluorodeoxyglucose (FDG) uptake that could be compatible with COVID-19 in 4 of 8 patients. The number of affected lobes ranged from 1-4. All patients were diagnosed with COVID-19 by PCR test when symptoms and/or lung findings worsened on the days after PET/CT. The time interval between the last anticancer treatment and COVID-19 diagnosis in five patients was ≤7 days. During the follow-up, six of the cases (75%) needed mechanical ventilation and died later. Conclusion: COVID-19 may be recognised early by detecting incidental findings in PET/CT, especially in asymptomatic cancer patients. Potential complications may be prevented by early diagnosis and anticancer therapy changes. Therefore, possible COVID-19 findings in PET/CT should be reported and the patient should be referred to relevant clinician.


Subject(s)
COVID-19 Testing/standards , COVID-19/diagnosis , Neoplasms/diagnosis , Positron Emission Tomography Computed Tomography/trends , Adult , COVID-19/complications , COVID-19/diagnostic imaging , COVID-19/virology , Female , Humans , Male , Middle Aged , Neoplasms/complications , Neoplasms/diagnostic imaging , Neoplasms/virology , Positron Emission Tomography Computed Tomography/standards , Positron-Emission Tomography , Radiopharmaceuticals/therapeutic use , SARS-CoV-2/pathogenicity , Tomography, X-Ray Computed
9.
Clin Nucl Med ; 47(1): e56-e58, 2022 Jan 01.
Article in English | MEDLINE | ID: covidwho-1240978

ABSTRACT

ABSTRACT: COVID vaccination has begun in most of the countries. Older population and high-risk groups are prioritized for vaccination. Postvaccination imaging in cancer patients may show effects of the immune response to the vaccine. As such, it is important to know the timing and laterality of the vaccination as the reactive lymph nodes in the ipsilateral axilla can be seen on the imaging. We present a case of DOTATATE-avid nonpathologically enlarged lymph nodes in ipsilateral axilla and linear tracer uptake in the deltoid muscle on a patient imaged for a recent diagnosis of rectal neuroendocrine neoplasm.


Subject(s)
COVID-19 Vaccines/administration & dosage , Lymph Nodes , Neoplasms/diagnostic imaging , Receptors, Somatostatin , Axilla , COVID-19/prevention & control , Humans , Lymph Nodes/diagnostic imaging , Male , Middle Aged , Positron-Emission Tomography , Radionuclide Imaging
11.
Radiol Imaging Cancer ; 2(6): e200058, 2020 11.
Article in English | MEDLINE | ID: covidwho-1155957

ABSTRACT

Patients with cancer have been negatively impacted during the coronavirus disease 2019 (COVID-19) pandemic, as many of these individuals may be immunosuppressed and of older age. Additionally, cancer follow-up or imaging appointments have been delayed in many clinics around the world. Postponement of routine screening exams will result in delays in new cancer diagnoses. Clinics are continuing to monitor and adapt their appointment schedules based on local outbreaks of COVID-19. Studies on COVID-19 in patients with cancer are limited, but consistently indicate that this population is at risk for more severe COVID-19 illness. Data from recent studies also suggest that pediatric patients with cancer have a lower risk of severe COVID-19 illness compared to adults. Certain features of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection detected by lung, brain, and gastrointestinal imaging may confound radiologists' interpretation of cancer diagnosis, staging, and treatment response. Lastly, as clinics begin to re-open for routine appointments, protocols have been put in place to reduce SARS-CoV-2 exposure to patients during their visits. This review details different perspectives on the impact of the COVID-19 pandemic on patients with cancer and on cancer imaging. Keywords: Abdomen/GI, Cardiac, Infection, Nervous-Peripheral.


Subject(s)
COVID-19/complications , Diagnostic Imaging/methods , Neoplasms/complications , Neoplasms/diagnostic imaging , Patient Care/methods , Humans , Pandemics , SARS-CoV-2
14.
Ann Otol Rhinol Laryngol ; 130(4): 424-428, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-737352

ABSTRACT

BACKGROUND: The inverted and oncocytic subtypes of sinonasal Schneiderian papillomas are benign tumors with possible rare malignant transformation and are typically managed with complete surgical resection and close follow-up. While computed tomography (CT) and magnetic resonance imaging (MRI) are mainstays in preoperative evaluation of bony invasion and soft tissue extension of the lesion, their imaging characteristics by 18F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) is less well characterized. OBJECTIVE: To describe the clinical presentation and management of a PET positive sinonasal lesion. To conduct a literature review of FDG uptake in benign sinonasal papillomas. METHODS: Case report (n = 1) and literature review of similar cases (n = 32). RESULTS: We report the case of a 69-year-old man presenting with an isolated left maxillary sinus mass with avid FDG uptake, discovered on PET/CT imaging. An endoscopic left maxillary mega-antrostomy provided successful definitive treatment for final pathologic diagnosis of oncocytic papilloma. Literature review of cases of sinonasal papillomas with avid FDG uptake found that oncocytic papillomas, on average, exhibit greater uptake than inverted papillomas and both may be mistaken as malignancies on PET. CONCLUSION: While PET imaging demonstrating avid FDG uptake is associated with an increased risk of malignancy, it does not rule out the possibility of a benign sinonasal papilloma nor other benign inflammatory lesions. Particularly, oncocytic papillomas may have very high FDG uptake and mimic malignant lesions.


Subject(s)
Adenoma, Oxyphilic , Fluorodeoxyglucose F18/pharmacology , Maxillary Sinus Neoplasms , Nasal Mucosa , Neoplasms/diagnostic imaging , Papilloma, Inverted , Positron Emission Tomography Computed Tomography/methods , Adenoma, Oxyphilic/diagnostic imaging , Adenoma, Oxyphilic/pathology , Aged , Diagnosis, Differential , Humans , Male , Maxillary Sinus Neoplasms/diagnostic imaging , Maxillary Sinus Neoplasms/pathology , Nasal Mucosa/diagnostic imaging , Nasal Mucosa/pathology , Papilloma, Inverted/diagnostic imaging , Papilloma, Inverted/pathology , Preoperative Care/methods , Radiopharmaceuticals/pharmacology
15.
Jpn J Radiol ; 38(11): 1007-1011, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-986668

ABSTRACT

OBJECTIVE: The aim of this case series is to describe our experience in diagnosis and management of oncological asymptomatic patients with COVID-19 who underwent 18F-FDG PET/CT. METHODS: From March 9 to March 31, 2020, we identified 5 patients who had PET/CT findings suspicious for COVID-19, but no symptom of infection. RESULTS: The first three patients were administered an SARS-CoV-2 test in a COVID-dedicated center, while the fourth and fifth were tested in our institution, in accordance with a new internal procedure. The SARS-CoV-2 test yielded positive results in all five patients. CONCLUSION: In this COVID-19 emergency, our task as radiologists and nuclear medicine physicians is to be able to identify imaging findings suggestive of the disease and to manage patients without overloading the hospital system.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Coronavirus Infections/diagnostic imaging , Fluorodeoxyglucose F18 , Neoplasms/complications , Neoplasms/diagnostic imaging , Pneumonia, Viral/complications , Pneumonia, Viral/diagnostic imaging , Positron Emission Tomography Computed Tomography/methods , COVID-19 , Humans , Lung/diagnostic imaging , Male , Middle Aged , Pandemics , Radiopharmaceuticals , SARS-CoV-2
16.
Hell J Nucl Med ; 23(3): 349-353, 2020.
Article in English | MEDLINE | ID: covidwho-971865

ABSTRACT

COVID-19 pandemic is having a strong impact on healthcare providers around the world, by refocusing and reducing non-essential medical activities. Nuclear medicine departments among others, have been reorganizing and reprioritizing diagnostic and theragnostic procedures. This reorganizing had a negative impact on the supply of positron emission tomography (PET) services to oncologic patients, whose health was affected. We herein present the PET findings in three different cancer scenarios in which disease course was dramatically affected by the COVID-19 outbreak.


Subject(s)
COVID-19/epidemiology , Neoplasms/epidemiology , Positron-Emission Tomography , Disease Progression , Humans , Infection Control/methods , Neoplasms/diagnostic imaging , Nuclear Medicine Department, Hospital/organization & administration , Nuclear Medicine Department, Hospital/statistics & numerical data , Oncology Service, Hospital/organization & administration , Oncology Service, Hospital/statistics & numerical data
18.
Biomedica ; 40(Supl. 2): 27-33, 2020 10 30.
Article in English, Spanish | MEDLINE | ID: covidwho-916544

ABSTRACT

COVID-19 is the viral infection caused by SARS-CoV-2 declared by the World Health Organization (WHO) as a pandemic. Patients with cancer have a higher risk to acquire the infection and worse prognosis as they have to attend more medical visits in healthcare institutions, receive medical and surgical treatments, and be subjected to diagnostic studies such as PET/CT in nuclear medicine services where the infection may be an incidental finding. We present here F18-FDG PET/CT (Positron Emission Tomography and Computed Tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose), images with findings of COVID-19 from patients with different oncological conditions but no respiratory symptoms.


La COVID-19 es la infección viral causada por el SARS-CoV-2 y declarada por la Organización Mundial de la Salud (OMS) como pandemia. Los pacientes con cáncer tienen un mayor riesgo de adquirir la infección y un peor pronóstico, ya que deben asistir a visitas médicas en diferentes centros hospitalarios, reciben tratamientos médicos y quirúrgicos y deben someterse a estudios diagnósticos como la PET/CT en servicios de medicina nuclear, lo que es ocasión para el hallazgo incidental de la infección. Se presentan las imágenes de tomografías computarizadas por emisión de positrones con 18-fluorodesoxiglucosa (F18) (Positron Emission Tomography and Computed Tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose, PET/CT F18-FDG) en las que se evidenció la COVID-19 en pacientes con diversas enfermedades oncológicas, pero sin sintomatología respiratoria.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections/diagnostic imaging , Incidental Findings , Neoplasms/complications , Pneumonia, Viral/diagnostic imaging , Positron Emission Tomography Computed Tomography , Adult , Aged , Asymptomatic Diseases , COVID-19 , COVID-19 Testing , Carcinoma, Signet Ring Cell/complications , Carcinoma, Signet Ring Cell/diagnostic imaging , Carcinoma, Signet Ring Cell/secondary , Clinical Laboratory Techniques , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Female , Fluorine Radioisotopes , Fluorodeoxyglucose F18 , Humans , Lymphatic Metastasis/diagnostic imaging , Lymphoma, Non-Hodgkin/complications , Lymphoma, Non-Hodgkin/diagnostic imaging , Male , Middle Aged , Neoplasms/diagnostic imaging , Pandemics , Pleural Effusion/diagnostic imaging , Pleural Effusion/etiology , Pneumonia, Viral/complications , Radiopharmaceuticals , Reverse Transcriptase Polymerase Chain Reaction , SARS-CoV-2 , Seminoma/complications , Seminoma/diagnostic imaging , Seminoma/secondary , Stomach Neoplasms
19.
Endoscopy ; 53(2): 166-170, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-882959

ABSTRACT

BACKGROUND: COVID-19 has dramatically affected gastrointestinal endoscopy practice. We aimed to investigate its impact on procedure types, indications, and findings. METHODS: We retrospectively analyzed endoscopies performed in 15 Dutch hospitals by comparing periods 15 March to 25 June of 2019 and 2020 using the prospective Trans.IT database. RESULTS: During lockdown in 2020, 9776 patients underwent endoscopy compared with 19 296 in 2019. Gastroscopies decreased by 57 % (from 7846 to 4467) and colonoscopies by 45 % (from 12219 to 5609), whereas endoscopic retrograde cholangiopancreatography volumes remained comparable (from 578 to 522). Although endoscopy results indicative of cancer decreased (from 524 to 340), the likelihood of detecting cancer during endoscopy increased (2.7 % [95 % confidence interval (CI) 2.5 - 3.0] in 2019 versus 3.5 % [95 %CI 3.1 - 3.9] in 2020; P < 0.001). After lifting of lockdown, endoscopy volumes started to return to normal, except for colorectal cancer screening. CONCLUSIONS: Fewer endoscopies were performed during the COVID-19 lockdown, leading to a significant reduction in the absolute detection of cancer. Endoscopies increased rapidly after lockdown, except for colorectal cancer screening.


Subject(s)
COVID-19 , Endoscopy, Gastrointestinal/statistics & numerical data , Neoplasms/diagnostic imaging , Pandemics , Databases, Factual , Humans , Netherlands , Retrospective Studies
20.
Cancer Treat Res Commun ; 25: 100214, 2020.
Article in English | MEDLINE | ID: covidwho-841265

ABSTRACT

During this COVID-19 pandemic, patients with symptoms such as fever, cough, sore throat, and coryza were advised to have RT-PCR testing for SARS-CoV-2 infection. We described here an elderly female with chronic lymphocytic leukemia, who presented with atypical symptoms that were not directly attributable to COVID-19. This patient was admitted to the non-COVID-19 ward for supportive care. Later, her chest x-ray revealed pneumonia that was confirmed to be COVID-19 by RT-PCR testing several days later. In resource-poor settings where molecular testing results suffered from delays or were altogether unavailable, the use of diagnostic imaging such as a chest x-ray could serve as a quick guide in the assessment and management of these patients especially if the imaging results suggest COVID-19 infection.


Subject(s)
COVID-19/diagnosis , Leukemia, Lymphocytic, Chronic, B-Cell/diagnostic imaging , Neoplasms/diagnosis , Pharyngitis/diagnosis , COVID-19/complications , COVID-19/diagnostic imaging , COVID-19/virology , Cough/complications , Cough/diagnosis , Cough/diagnostic imaging , Cough/virology , Female , Humans , Leukemia, Lymphocytic, Chronic, B-Cell/complications , Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis , Leukemia, Lymphocytic, Chronic, B-Cell/virology , Neoplasms/complications , Neoplasms/diagnostic imaging , Neoplasms/virology , Pandemics , Pharyngitis/complications , Pharyngitis/diagnostic imaging , Pharyngitis/virology , SARS-CoV-2/pathogenicity , X-Rays
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