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

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.