In general, the identification of pulmonary GGOs or patients presenting with persistent fever should prompt additional diagnostic testing for differential diagnosis—including 18F-FDG PET/CT imaging. Here, we report the 18F-FDG PET/CT findings from four patients who were admitted to the Wuhan Union Hospital with lung GGOs and fever between January 13 and January 20, 2020—when the COVID-19 outbreak was still unrecognized and the virus infectivity was unknown. A retrospective review of the patients’ medical history, clinical and laboratory data, as well as imaging findings (Table 1) strongly suggested a diagnosis of COVID-19.
Table 1 General characteristics and PET/CT findings of four cases with COVID-19
Patient number 1 2 3 4
Sex Man Man Woman Woman
Age, years 57 56 61 48
Clinical symptoms Fever, sore throat Fever, fatigue, dizziness Back pain, dry cough Fever, chill, dry cough, myalgia, and fatigue
History of staying in Wuhan Yes Yes Yes Yes
WBC (× 109/L) (reference range 3.5–9.5 × 109/L) Normal 3.33 3.47 Normal
Lymphocytes (%) (reference range 20–40%) Normal 17.5% Normal Normal
HsCRP (mg/L) (reference range 0–5 mg/L) 6.65 23.6 Not available 12.2
Respiratory pathogens* Negative Negative Not available Negative
PET/CT findings Number of affected lobes 2 (RUL, LLL) 5 (all lobes) 3 (RUL, RLL, LLL) 3 (RML, RLL, LLL)
Lung CT features GGO GGO and consolidative opacities GGO GGO with interlobular septal thickening
SUVmax 4.6 7.9 12.2 9.3
LN involvement Absent Right subclavian region, mediastinum Right supraclavicular region, mediastinum Right subclavian region, mediastinum, right hilar region
LN SUVmax – 7 5.4 5.5
Concomitant diseases** Absent Absent Absent Absent
*The following respiratory pathogens were investigated: Mycoplasma pneumoniae, Chlamydia pneumoniae, adenovirus, respiratory syncytial virus, and Coxsackie B-virus specific IgM
**Including malignancies and other infectious diseases
WBC, white blood cell; hsCRP, high-sensitivity C-reactive protein; LN, lymph node; RUL, right upper lobe; RML, right middle lobe; RLL, right lower lobe; LUL, left upper lobe; LLL, left lower lobe; GGO, ground-glass opacities; SUV, standardized uptake value