Unforeseen COVID-19 on Oncologic Bone Scan with SPECT/CT in a High Prevalence Area

Area of Science:

• Nuclear Medicine
• Radiology
• Infectious Disease Imaging

Background:

• Nuclear medicine imaging, particularly bone scintigraphy with SPECT/CT, is typically used for evaluating bone metastases and other skeletal abnormalities.
• The Coronavirus Disease-2019 (COVID-19) pandemic has introduced novel challenges in medical diagnostics, including the potential for atypical imaging findings.
• Incidental pulmonary findings on scans performed for other indications require careful interpretation in the context of patient symptoms and potential exposures.

Purpose of the Study:

• To highlight the potential for detecting Coronavirus Disease-2019 (COVID-19) related pulmonary findings on technetium methylene diphosphonate (Tc-99m MDP) bone scans with SPECT/CT.
• To raise awareness among nuclear physicians about the importance of considering COVID-19 in the differential diagnosis for pulmonary abnormalities observed during routine SPECT/CT imaging.

Main Methods:

• Retrospective analysis of two patients who underwent Tc-99m MDP bone scans with SPECT/CT for reasons unrelated to pulmonary symptoms.
• Detailed review of imaging findings, specifically focusing on pulmonary opacities and nodular densities observed on SPECT/CT.
• Correlation of imaging findings with subsequent COVID-19 testing and clinical outcomes.

Main Results:

• The first patient, a 65-year-old woman with a history of breast cancer and hepatocellular carcinoma, presented with MDP nonavid and scattered bilateral pulmonary ground-glass opacities and rounded nodular densities on SPECT/CT.
• The second patient, a 56-year-old woman newly diagnosed with breast cancer, showed bilateral pulmonary infiltrates on bone scan with SPECT/CT.
• Both patients subsequently tested positive for COVID-19, suggesting these imaging findings were indicative of the infection.

Conclusions:

• Pulmonary findings such as ground-glass opacities and infiltrates on Tc-99m MDP SPECT/CT can be associated with COVID-19 infection.
• Nuclear physicians should maintain a high index of suspicion for COVID-19 when encountering such pulmonary abnormalities, even on scans not primarily intended for lung evaluation.
• Recognizing these findings is crucial as COVID-19 becomes an increasingly common consideration in differential diagnoses across various medical specialties.