- Case Report
- Open Access
Pulmonary Tc99m-PSMA uptake in asymptomatic COVID-19 patient: incidental finding in SPECT/CT study
Egyptian Journal of Radiology and Nuclear Medicine volume 53, Article number: 70 (2022)
As there are comparative studies between 68Ga-PSMA and 99mTc-PSMA and spectrum of PSMA expression, this is the first case report that notifies distribution of 99mTc-PSMA on COVID-19 pneumonia era on the literature.
An asymptomatic 70-Y-old male who is known case of prostate adenocarcinoma underwent initial staging. SPECT/CT of the chest region reveals bilateral peripheral multifocal ground glass opacities which shows 99mTc-PSMA uptake. Diagnosis of corona virus was confirmed by positive RT-PCR.
Unexclusive role of radiotracers in nuclear medicine has an importance for wide range of applications. Comparison between 68Ga-PSMA and 99mTc-PSMA in detection of metastatic disease in prostate cancer is also under evaluation.
This case implicates possible role of PSMA imaging in inflammation/infection process as well as necessity for lung review in hybrid imaging especially during this recent pandemic.
A spectrum of PSMA expression in benign and malignant findings such as infectious/inflammatory process was reported . There are few reports for 68Ga-PSMA uptake in COVID-19 pneumonia . But there is no previously reported case of 99mTC-PSMA on COVID-19 as our knowledge. It is also decisive for nuclear medicine physician to know the other possible reasons of 99mTC-PSMA uptake for the best interpretation.
A 70-Y-old male who have biopsy proven prostate adenocarcinoma with Gleason score of 6 (3 + 3) and PSA level 36 ng/ml underwent a 99mTc-PSMA SPECT-CT for initial staging.
A dose of 20 mci (740 MBq) was injected intravenously, and 4 h later, whole-body images and thoracoabdominopelvic SPECT/CT images were performed using the Siemens Symbia Intevo SPECT/CT dual-head variable angle gamma camera.
SPECT/CT scan images revealed heterogeneous PSMA uptake in prostate lobes consistent with previously known malignancy. An incidental finding of multifocal, bilateral and peripheral ground-glass opacities in lungs with mild 99mTC-PSMA uptake are noticed (Fig. 1). Otherwise, no abnormal PSMA avid lesions are seen throughout the body.
Regarding viral outbreak, the first diagnosis is COVID-19 pneumonia. Although the patient had no any respiratory symptoms, RT-PCR was performed and the result was positive.
Unexclusive role of radiotracers in nuclear medicine has an importance in wide range of applications. Not to misinterpret, every 99mTc-PSMA uptake in lung fields as metastasis in staging of a prostate adenocarcinoma is crucial. Comparison between 68Ga-PSMA and 99m Tc-PSMA in detection of metastatic disease in prostate cancer is still under evaluation [3, 4]. There are few case reports of incidental detection of COVID-19-associated pneumonia by different tracers on nuclear medicine examinations such as 68Ga-PSMA PET/CT, 18F-FDG PET/CT and thyroid scintigraphy [5,6,7,8].
This case implicates the possible role of PSMA imaging in active inflammatory/infectious process. This may be useful for evaluation of response to treatment of inflammatory disease. Also, as many COVID-19 patients are asymptomatic, it is necessary for nuclear medicine departments to review lung window filed in hybrid imaging even in unrelated pathologies.
Availability of data and materials
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
68 Gallium-prostate-specific membrane antigen
Technetium-99m-prostate-specific membrane antigen
Single-photon emission computed tomography/computed tomography
Reverse transcription polymerase chain reaction
Positron emission tomography/computed tomography
De Galiza BF, Queiroz MA, Nunes RF, Costa LB, Zaniboni EC, Marin JFG, Cerri GG, Buchpiguel CA (2020) Nonprostatic diseases on PSMA PET imaging: a spectrum of benign and malignant findings. Cancer Imaging 20(1):23. https://doi.org/10.1186/s40644-020-00300-7
Morón S, González E, Rojas J (2020) 68Ga-PSMA PET/CT with incidental finding of COVID-19 in an asymptomatic patient. Clin Nucl Med 45(12):1032–1033. https://doi.org/10.1097/RLU.0000000000003388
Fallahi B, Khademi N, Karamzade-Ziarati N, Fard-Esfahani A, Emami-Ardekani A, Farzanefar S, Eftekhari M, Beiki D (2021) 99mTc-PSMA SPECT/CT versus 68Ga-PSMA PET/CT in the evaluation of metastatic prostate cancer. Clin Nucl Med 46(2):e68–e74. https://doi.org/10.1097/RLU.0000000000003410
Albalooshi B et al (2020) Direct comparison of 99mTc-PSMA SPECT/CT and 68Ga-PSMA PET/CT in patients with prostate cancer. Asia Ocean J Nucl Med Biol 8(1):1–7
Stasiak CES, Cardoso FR, de Almeida SA, Rosado-de-Castro PH (2021) Incidental finding of COVID-19 infection after [68Ga]Ga-PSMA-11 PET/CT imaging in a patient with prostate cancer. Eur J Nucl Med Mol Imaging 48(2):653–654. https://doi.org/10.1007/s00259-020-04932-6
Ali SA, Abdelkawi MM (2020) Incidentally recognized COVID-19 pneumonia in routine oncologic 18F-FDG PET/CT examinations: a local experience during pandemic era. Egypt J Radiol Nucl Med 51(1):220. https://doi.org/10.1186/s43055-020-00333-9
Jafari F, Alavi M (2021) Incidental detection of COVID-19 associated pneumonia by [99mTc]UBI scintigraphy. Nucl Med Rev Cent East Eur 24(2):110–112. https://doi.org/10.5603/NMR.2021.0025
Tulchinsky M, Fotos JS, Slonimsky E (2020) Incidental CT findings suspicious for COVID-19-associated pneumonia on nuclear medicine examinations: recognition and management plan. Clin Nucl Med 45(7):531–533. https://doi.org/10.1097/RLU.0000000000003100
There were no sources of funding (institutional, private and corporate financial support) for the work reported in this paper.
Ethics approval and consent to participate
There was no conflict of interest either in designing and accomplishment of this study. Data is available: This manuscript has been read and approved by all the authors which represent our honest report of hard working. The material has not been previously published or submitted elsewhere for publication. There were no sources of funding (institutional, private and corporate financial support) for the work reported in this paper. Authors confirm that the statements of written informed consent from legally authorized representatives/parents/guardians are available.
Consent for publication
Authors confirm that the statements of written informed consent from legally authorized representatives/parents/guardians are available.
The authors declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Kalantari, F., Vali, R., Kalantari, E. et al. Pulmonary Tc99m-PSMA uptake in asymptomatic COVID-19 patient: incidental finding in SPECT/CT study. Egypt J Radiol Nucl Med 53, 70 (2022). https://doi.org/10.1186/s43055-022-00750-y
- Prostate cancer