Avoid common mistakes on your manuscript.
In patients suffering from 2019 novel coronavirus disease (COVID-19) and associated pulmonary infiltrates, pulmonary embolism (PE) represents a differential diagnosis which could alter therapy [1]. The gold standard to rule out significant PE in patients with COVID-19 pneumonia is a contrast-enhanced CT-scan (ceCT) [2, 3]. In patients with contraindications for iodinated contrast-media, perfusion single-photon emission tomography (SPECT) using [99mTc]-labeled-macroaggregated albumin (MAA) could be an alternative. We present a 59-year-old female patient, with high fever and respiratory symptoms since 1 week. A swab test was COVID-19 positive, matching typical mild ground-glass infiltration on an unenhanced CT scan (Fig. 1a), with a CT-based total severity score (TSS) of 4 [4]. The initial D-dimer was 935 μg/l. Supportive therapy and prophylactic anticoagulation was initiated. Although she reported clinical improvement, oxygen demand increased after 6 days. Ruling out PE with ceCT was not possible due to known severe anaphylactic reactions in the past despite premedication. A SPECT/CT with 180 MBq [99mTc]-MAA was acquired. Despite large wedge-shaped perfusion defects on SPECT (Fig. 1 b) the scan ruled out significant PE, given that all perfusion defects correlated with pulmonary infiltrates or consolidations in the CT lung window, which would result in ventilation defects on V/Q-scans (Fig. 1c, d), as further explained in the accompanying editorial [5]. The TSS for the second CT was 12, compatible with severe to critical disease [4]. Three days later, the D-dimer dropped to 409 μg/l without initiation of therapeutic anticoagulation. Respiratory distress increased, indicating invasive ventilation. After 5 days of invasive ventilation, the pulmonary capacity started to improve again, and the patient recovered.
References
Thachil J, Tang N, Gando S, Falanga A, Cattaneo M, Levi M, et al. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. n/a. https://doi.org/10.1111/jth.14810.
Xie Y, Wang X, Yang P, Zhang S. COVID-19 complicated by acute pulmonary embolism. 2020;2:e200067. https://doi.org/10.1148/ryct.2020200067.
Danzi GB, Loffi M, Galeazzi G, Gherbesi E. Acute pulmonary embolism and COVID-19 pneumonia: a random association? Eur Heart J. 2020. https://doi.org/10.1093/eurheartj/ehaa254.
Li K, Fang Y, Li W, Pan C, Qin P, Zhong Y, et al. CT image visual quantitative evaluation and clinical classification of coronavirus disease (COVID-19). Eur Radiol. 2020. https://doi.org/10.1007/s00330-020-06817-6.
Burger IA, Niemann T, Patriki D, François F, Beer JH. Is there a role for lung perfusion [99mTc]-MAA SPECT/CT to rule out pulmonary embolism in COVID-19 patients with contraindications for iodine contrast? Eur J Nucl Med Mol Imaging. 2020. https://doi.org/10.1007/s00259-020-04837-4.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare that they have no competing interests.
Ethics approval
Not applicable.
Informed consent
General consent for case publication was given by patient.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Infection and inflammation
Rights and permissions
About this article
Cite this article
Burger, I.A., Niemann, T., Patriki, D. et al. Lung perfusion [99mTc]-MAA SPECT/CT to rule out pulmonary embolism in COVID-19 patients with contraindications for iodine contrast. Eur J Nucl Med Mol Imaging 47, 2209–2210 (2020). https://doi.org/10.1007/s00259-020-04862-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00259-020-04862-3