Evolution of 18F-FDG PET/CT Findings in Patients After COVID-19: An Initial Investigation

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 (TBR_lung = SUV_max/SUV_min) and compared with temporal stage. Results: In acute COVID-19, less than 3 wk after infection, TBR_lung 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, TBR_lung 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.

Keywords: 18F-FDG; COVID-19; PET/CT; infectious disease; respiratory.