[18F]FDG-PET/CT in mechanically ventilated critically ill patients with COVID-19 ARDS and persistent inflammation

Bram van Leer; Johannes H van Snick; Mark Londema; Maarten W N Nijsten; Ömer Kasalak; Riemer H J A Slart; Andor W J M Glaudemans; Janesh Pillay

doi:10.1007/s40336-023-00550-y

[¹⁸F]FDG-PET/CT in mechanically ventilated critically ill patients with COVID-19 ARDS and persistent inflammation

Clin Transl Imaging. 2023;11(3):297-306. doi: 10.1007/s40336-023-00550-y. Epub 2023 Mar 12.

Authors

Bram van Leer^{1

2}, Johannes H van Snick¹, Mark Londema^{1

2}, Maarten W N Nijsten², Ömer Kasalak³, Riemer H J A Slart^{1

4}, Andor W J M Glaudemans¹, Janesh Pillay^{2

5}

Affiliations

¹ Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
² Department of Critical Care, University Medical Center Groningen, University of Groningen, TA29, PO box: 30 001, 9700 RB Groningen, The Netherlands.
³ Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
⁴ Biomedical Photonic Imaging Group, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands.
⁵ Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Abstract

Purpose: We report the findings of four critically ill patients who underwent an [¹⁸F]FDG-PET/CT because of persistent inflammation during the late phase of their COVID-19.

Methods: Four mechanically ventilated patients with COVID-19 were retrospectively discussed in a research group to evaluate the added value of [¹⁸F]FDG-PET/CT.

Results: Although pulmonary PET/CT findings differed, bilateral lung anomalies could explain the increased CRP and leukocytes in all patients. This underscores the limited ability of the routine laboratory to discriminate inflammation from secondary infections. Based on PET/CT findings, a secondary infection/inflammatory focus was suspected in two patients (pancreatitis and gastritis). Lymphadenopathy was present in patients with a detectable SARS-CoV-2 viral load. Muscle uptake around the hips or shoulders was observed in all patients, possibly due to the process of heterotopic ossification.

Conclusion: This case series illustrates the diagnostic potential of [¹⁸F]FDG-PET/CT imaging in critically ill patients with persistent COVID-19 for the identification of other causes of inflammation and demonstrates that this technique can be performed safely in mechanically ventilated critically ill patients.

Keywords: ARDS; COVID-19; Critically ill patients; ICU; Persistent inflammation; [18F]FDG-PET/CT.