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Review
. 2021 Nov;48(12):3903-3917.
doi: 10.1007/s00259-021-05347-7. Epub 2021 May 19.

Positron emission tomography in the COVID-19 pandemic era

Chentao Jin #  1   2   3 , Xiaoyun Luo #  1   2   3 , Shufang Qian  1   2   3 , Kai Zhang  4 , Yuanxue Gao  1   2   3 , Rui Zhou  1   2   3 , Peili Cen  1   2   3 , Zhoujiao Xu  1   2   3 , Hong Zhang  5   6   7   8   9 , Mei Tian  10   11   12
Affiliations
Review

Positron emission tomography in the COVID-19 pandemic era

Chentao Jin et al. Eur J Nucl Med Mol Imaging. 2021 Nov.

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.

Keywords: COVID-19; Molecular imaging; Positron emission tomography (PET); SARS-CoV-2.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Schematic diagram illustrating the role of PET in the pandemic era. A variety of clinical applications of PET imaging have been reported, facilitating the evaluation of pulmonary inflammation, ARDS, pulmonary embolism, pulmonary fibrosis, cerebral dysfunction, and cardiac injury (a), by using various PET molecular probes (b). PET enables the whole-body evaluation for COVID-19 patients in molecular perspectives (c), helping the exploration of pathophysiological changes of molecular targets in different COVID-19 phases by using specific radiotracers (d), as well as the exploration of COVID-19 pathogenic mechanisms through the visualization of molecules involved in the occurrence and development of COVID-19 (e)
Fig. 2
Fig. 2
Incidental detection of COVID-19 in an 82-year-old patient with a history of adenocarcinoma of the colon. Increased 18F-FDG uptake (SUVmax 8.6) was observed in the bilateral lung fields (a, maximal intensity projection image; b–d, axial fused PET/CT images), corresponding to the bilateral ground-glass opacities on CT (e–g, axial CT images). Physiologic activity was also observed in the bowel indicated by a black arrow in the PET image (reproduced by permission from reference [27])
Fig. 3
Fig. 3
Examples of PET/CT images of COVID-19 patients using 68Ga-PSMA-11 and 18F-choline. a 68Ga-PSMA-11 PET/CT of an asymptomatic 66-year-old man, who requested for primary staging of prostate cancer. Peripheral ground-glass opacities on both lungs were observed on CT, with mild bronchial uptake of 68Ga-PSMA-11 (SUVmax 4.4). b 18F-choline PET/CT images of an asymptomatic 59-year-old man with biochemical recurrence of prostate cancer. Bilateral ground glass opacities were identified, with increased 18F-choline uptake (SUVmax range 3–4) (reproduced by permission from reference [42, 43])
Fig. 4
Fig. 4
18F-FDG PET/CT images of lymph nodes in a COVID-19 patient. Increased 18F-FDG uptake was observed in mediastinal and hilar lymph nodes in the first scan 4 weeks after the symptom occurrence. The 18F-FDG uptake was decreased in the second examination 4 weeks after first scan (reproduced by permission from reference [53])
Fig. 5
Fig. 5
18F-αvβ6-BP PET/CT images of a COVID-19-recovered patient 2 months after infection. Axial CT (left), 18F-αvβ6-BP PET (middle), and fused PET/CT (right) images showed increased 18F-αvβ6-BP uptake (SUVmax 5) and bilateral patchy opacity (reproduced by permission from reference [91])
Fig. 6
Fig. 6
Brain 18F-FDG PET image of a COVID-19 patient with 4-week prolonged anosmia. Hypometabolism was observed in the olfactory/rectal gyrus (white arrow) and confirmed by voxel-to-voxel comparison with healthy subjects in SPM analysis (p voxel < 0.001, p-cluster < 0.05, uncorrected) (reproduced by permission from reference [97])
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