Prevalence of interstitial pneumonia suggestive of COVID-19 at (18)F-FDG PET/CT in oncological asymptomatic patients in a high prevalence country during pandemic period: a national multi-centric retrospective study.


Collaborators: Bonacina M, Laudicella R, Spallino M, Palucci A, Cuzzocrea M, Donner M, Maurea S, Ceci F, Dei Rossi F, Tranfaglia B, Sartorello A, Gandolfo P, Buschiazzo A, Scarale A, Kirienko M, Merenda N, Nappi AG, Durmo R, Vellani C, Ceriani V.
Author information:
(1)Nuclear Medicine, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy. [Email]
(2)Nuclear Medicine, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy.
(3)Unit of Nuclear Medicine, Fondazione Istituto G.Giglio, 90015, Cefalù, Italy.
(4)Department of Biomedical and Dental Sciences and of Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, 98125, Messina, Italy.
(5)Nuclear Medicine Department, Ospedale San Donato, Arezzo, Italy.
(6)Nuclear Medicine Department, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy.
(7)Nuclear Medicine Department, Treviso Hospital, Treviso, Italy.
(8)Nuclear Medicine Unit, ARNAS G. Brotzu, Cagliari, Italy.
(9)Nuclear Medicine, IRCCS CRO, Aviano, Italy.
(10)Department of Nuclear Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy.
(11)Department of Nuclear Medicine, "Ospedali Riuniti di Torrette" Hospital, Ancona, Italy.
(12)Service Department Macerata Hospital, ASUR Marche AV3, Nuclear Medicine Unit, Macerata, Italy.
(13)Nuclear Medicine Department, Fondazione IRCCS Cà Grande Ospedale Maggiore Policlinico, Milan, Italy.
(14)Nuclear Medicine Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy.
(15)Nuclear Medicine, S. Chiara Hospital, Trento, Italy.
(16)Nuclear Medicine Unit, S. Andrea Hospital, La Spezia, Italy.
(17)Department of Nuclear Medicine, Sant'Anna Hospital, Como, Italy.
(18)Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy.
(19)Nuclear Medicine Unit, AO Ospedali Dei Colli, Monaldi Hospital, Naples, Italy.
(20)Division of Nuclear Medicine, Department of Medical Sciences, University of Turin, AOU Città della Salute e della Scienza, 10126, Turin, Italy.
(21)Department of Diagnostic Imaging, Nuclear Medicine Unit, Ospedale "S. Maria della Misericordia", Perugia, Italy.
(22)Nuclear Medicine, Neuromed, Pozzilli, Italy.
(23)Nuclear Medicine, Central Hospital Bolzano, Bolzano, Italy.
(24)Department of Nuclear Medicine, IRCCS MultiMedica Sesto San Giovanni, Milan, Italy.
(25)Division of Nuclear Medicine, European Institute of Oncology, IRCCS, Milan, Italy.
(26)Nuclear Medicine Unit, Veneto Institute of Oncology IOV-IRCCS, Castelfranco Veneto, Italy.
(27)Nuclear Medicine, University of Milan Bicocca and ASST Ospedale San Gerardo, Monza, Italy.
(28)Nuclear Medicine Unit, S. Maria Hospital, Terni, Italy.
(29)Division of Nuclear Medicine, Ospedale S. Bortolo, Vicenza, Italy.
(30)Unit of Nuclear Medicine, Department of Radiology and Clinical Radiotherapy, SS Annunziata Hospital, Chieti, Italy.
(31)Nuclear Medicine Department, University Hospital Ospedali Riuniti, Foggia, Italy.
(32)IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
(33)Department of Health Science
(DISSAL), University of Genoa, Genoa, Italy.
(34)Nuclear Medicine Department, Azienda Ospedaliera S.S. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy.
(35)IRCCS SDN, Naples, Italy.
(36)Section of Nuclear Medicine and Health Physics, Department of Medicine and Surgery-University of Perugia, Perugia, Italy.
(37)Unit of Diagnostic Imaging and Stereotactic Radiosurgery, CDI Centro Diagnostico Italiano,, Via Saint Bon 20, 20147, Milan, Italy.
(38)Nuclear Medicine Department, S. Croce e Carle Hospital Cuneo, Cuneo, Italy.
(39)Department of Nuclear Medicine, Mauriziano Hospital, Turin, Italy.
(40)Unit of Nuclear Medicine, Aosta Regional Hospital, Aosta, Italy.
(41)Department of Nuclear Medicine, Studio Radiologico Guidonia, Guidonia, Italy.
(42)Nuclear Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
(43)Nuclear Medicine, Azienda Socio Sanitaria Territoriale di Mantova. Ospedale C. Poma, Mantova, Italy.
(44)Nuclear Medicine Unit, Department of Interdisciplinary Medicine, AOU Policlinico, University of Bari, Bari, Italy.
(45)Nuclear Medicine Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
(46)Nuclear Medicine Department, AOU Maggiore della Carità, Novara, Italy.
(47)Nuclear Medicine Department, Fondazione Poliambulanza, Brescia, Italy.
(48)Nuclear Medicine Unit, ASM Matera, Matera, Italy.
(49)Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.
(50)Nuclear Medicine Unit, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy.
(51)Division of Nuclear Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
(52)Unit of Nuclear Medicine, Department of Diagnostic Imaging, N.O.P. - S. Stefano, U.S.L. Toscana Centro, Prato, Italy.
(53)Nuclear Medicine Unit, Dell'Angelo Hospital, Mestre-Venezia, Italy.
(54)Nuclear Medicine Unit, Department of Medical, Surgical and Experimental sciences, University of Sassari, Sassari, Italy.
(55)Nuclear Medicine Department, IRCCS CROB, Referral Cancer Center of Basilicata, 85028, Rionero in Vulture, Italy.
(56)Nuclear Medicine Department, Azienda Usl Toscana sud est, Arezzo, Italy.
(57)Nuclear Medicine Department, ICS Maugeri SpA SB-IRCCS, Pavia, Italy.
(58)Nuclear Medicine Unit, Azienda AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
(59)Nuclear Medicine Department, ASST Ovest Milanese, Legnano, Italy.
(60)Regional Center of Nuclear Medicine, University Hospital of Pisa, Pisa, Italy.
(61)Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore, & UOC di Medicina Nucleare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy.
(62)Department of Nuclear Medicine PET/CT Centre, S. Maria della Misericordia Hospital, 45100, Rovigo, Italy.
(63)Nuclear Medicine Department, ASP Agrigento, Agrigento, Italy.
(64)Nuclear Medicine Unit, Department of Medicine-DIMED, University of Padova, 35128, Padova, Italy.
(65)Department of Radiology, University of Brescia, ASST Spedali Civili Brescia, Brescia, Italy.
(66)Department of Biomedicine and Prevention, Tor Vergata University Hospital, Rome, Italy.


PURPOSE: To assess the presence and pattern of incidental interstitial lung alterations suspicious of COVID-19 on fluorine-18-fluorodeoxyglucose positron emission tomography (PET)/computed tomography (CT) ([18F]FDG PET/CT) in asymptomatic oncological patients during the period of active COVID-19 in a country with high prevalence of the virus. METHODS: This is a multi-center retrospective observational study involving 59 Italian centers. We retrospectively reviewed the prevalence of interstitial pneumonia detected during the COVID period (between March 16 and 27, 2020) and compared to a pre-COVID period (January-February 2020) and a control time (in 2019). The diagnosis of interstitial pneumonia was done considering lung alterations of CT of PET. RESULTS: Overall, [18F]FDG PET/CT was performed on 4008 patients in the COVID period, 19,267 in the pre-COVID period, and 5513 in the control period. The rate of interstitial pneumonia suspicious for COVID-19 was significantly higher during the COVID period (7.1%) compared with that found in the pre-COVID (5.35%) and control periods (5.15%) (p < 0.001). Instead, no significant difference among pre-COVID and control periods was present. The prevalence of interstitial pneumonia detected at PET/CT was directly associated with geographic virus diffusion, with the higher rate in Northern Italy. Among 284 interstitial pneumonia detected during COVID period, 169 (59%) were FDG-avid (average SUVmax of 4.1). CONCLUSIONS: A significant increase of interstitial pneumonia incidentally detected with [18F]FDG PET/CT has been demonstrated during the COVID-19 pandemic. A majority of interstitial pneumonia were FDG-avid. Our results underlined the importance of paying attention to incidental CT findings of pneumonia detected at PET/CT, and these reports might help to recognize early COVID-19 cases guiding the subsequent management.