SNMMI Statement: Possible Effect of Omicron Infection on FDG PET/CT Scans

January 14, 2022

As a professional society representing more than 16,000 nuclear medicine professionals, it is SNMMI’s responsibility to distribute information relevant to the evolving COVID-19 pandemic to our members as we navigate through various ups and downs of each successive wave. Over the past 18 months, the SNMMI COVID-19 Task Force has met bi-weekly to monitor, support, educate, and provide guidance to the nuclear medicine and molecular imaging community. 

The Task Force members have recently observed an unusual imaging pattern on FDG PET/CT or FDG PET/MR that may be due to COVID-19 infection.

Unlike the FDG PET/CT pattern seen with infections from previous strains of COVID-19, with principal involvement of the lungs, this new array of findings is primarily centered in the upper aerodigestive tract and cervical lymph nodes. Specifically, there is prominent, symmetric FDG uptake throughout the nasopharynx, oropharynx and tonsils with or without associated FDG-avid cervical lymphadenopathy, particularly in the suprahyoid neck. Based on what we know about the Omicron variant, it is conceivable that this pattern, whenever correlated with COVID-19 infection, is a result of the presently dominant Omicron strain. 

The Task Force recommends that this pattern should be taken into consideration at the time of FDG PET/CT interpretations and the possibility of infection with Omicron variant of COVID-19 should be entertained in the differential diagnosis. Since this pattern can by no means be diagnostic of COVID-19 infection, the Task Force makes the following recommendations.

  1. Check the patient records to see if there is a recent positive COVID-19 test.
  2. Determine if the patient is at higher risk of COVID-19 infection based on current symptoms or due to recent exposure or travel. If so, a recommendation can be made to test for COVID-19 in the appropriate setting.
  3. Compare with prior FDG PET/CT examinations and the patient’s history to determine if this represents chronic inflammatory/reactive process or stable malignancy such as lymphoma.
  4. Various differential diagnostic possibilities should be considered if this pattern is new or if there is interval progression including, but not limited to, infection with COVID-19, other viruses such as Epstein-Barr virus, malignancy and bacterial infections.
  5. This pattern may also be seen in children and younger adults but should be interpreted cautiously in view of normal increased activity that can be physiologic. Correlation with history and symptoms and comparison to prior examinations is recommended.

 

 

Nuclear Medicine–Specific Information

NOTE: See next tab for recent articles on nuclear medicine and COVID-19.


COVID Forum

Nuclear Medicine Used for COVID
  • Radioimmunotherapy may help treat COVID-19 (June 16) 
    Monopar Therapeutics and NorthStar Medical Radioisotopes have announced a collaboration to develop potential radioimmunotherapeutics to treat severe COVID-19.

Nuclear Medicine Webinars
SNMMI COVID-19 Industry Partners Satellite Symposium Webinars
Vaccination Recommendation 
  • SNMMI COVID-19 Task Force Vaccination Recommendation (June 2021)
    To ensure the health and safety of our family, friends, colleagues and patients, the SNMMI COVID-19 Task Force strongly urges all eligible SNMMI members and healthcare professionals to be vaccinated as soon as possible.
Nuclear Medicine Guidelines
COVID-Related Advocacy
Radioisotope Supply
Ventilation/Perfusion (V/Q) Studies

The Journal of Nuclear Medicine (JNM) 

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Absolute lymphocyte count after COVID-19 vaccination is associated with vaccine-induced hypermetabolic lymph nodes on 18F-FDG PET/CT: a focus in breast cancer care (ahead of print Dec 2021)
Romain-David Seban, Capucine Richard, Camila Nascimento-Leite, Jerome Ghidaglia, Claire Provost, Julie Gonin, Christophe Le Tourneau, Emanuela Romano, Nicolas Deleval and Laurence Champion

Imaging in Post-COVID Lung Disease (PCLD): does [18F]-FDG-PET/CT have the Key? (ahead of print October 2021)
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Lung scintigraphy for pulmonary embolism diagnosis in COVID-19 patients: a multicenter study (ahead of print October 2021)
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Neuropsychological Profiles and Cerebral Glucose Metabolism in Neurocognitive Long COVID-syndrome (Ahead of print Oct 2021)
Andrea Dressing, Tobias Bormann, Ganna Blazhenets, Nils Schroeter, Lea I Walter, Johannes Thurow, Dietrich August, Hanna Hilger, Katarina Stete, Kathrin Gerstacker, Susan Arndt, Alexander Rau, Horst Urbach, Siegbert Rieg, Dirk Wagner, Cornelius Weiller, Philipp T Meyer and Jonas A Hosp

18F-FDG–Avid Axillary Lymph Nodes After COVID-19 Vaccination (October 2021)
B. Jake Johnson, Kathryn M. Van Abel, Daniel J. Ma and Derek R. Johnson

Postinfectious Neurologic Complications in COVID-19: A Complex Case Report (August 2021)
Pietro Tiraboschi, Rubjona Xhani, Simone M. Zerbi, Angelo Corso, Isabella Martinelli, Laura Fusi, Giampiero Grampa, Andrea Lombardo, Paola Cavalcante, Cristina Cappelletti, Francesca Andreetta, Alberto Sironi, Alberto Redolfi and Cristina Muscio

Experience with a perfusion-only screening protocol for evaluation of pulmonary embolism during the COVID-19 pandemic surge (ahead of print August 2021)
Arun Kumar, Renee M. Moadel, Linda B. Haramati, Kenny Ye, Leonard M. Freeman and Lionel S. Zuckier

Lessons learned from post-COVID-19 vaccination PET/CT studies (ahead of print July 2021)
Marina Orevi, Alexandre Chicheportiche and Simona Ben-Haim

Evolution of 18F-FDG-PET/CT findings in patients following COVID-19 pneumonia: An Initial Investigation (ahead of print July 2021)
Andrew Thornton, Francesco Fraioli, Simon Wan, Helen S Garthwaite, Balaji Ganeshan, Robert Ian Shortman, Raymond Endozo, Stefan Voo, Irfan Kayani, Deena Neriman, Leon Menezes, Jamshed B. Bomanji, Toby Hillman, Melissa Heightman, Joanna C Porter and Ashley M Groves

Low but Evident Recovery from Neocortical Dysfunction and Cognitive Impairment in a Series of Chronic COVID-19 Patients (July 2021)
Ganna Blazhenets, Nils Schroeter, Tobias Bormann, Johannes Thurow, Dirk Wagner, Lars Frings, Cornelius Weiller, Philipp T. Meyer, Andrea Dressing and Jonas A. Hosp

V/Q SPECT/CT in the Time of COVID-19: Changing the Order to Improve Safety Without Sacrificing Accuracy (July 2021)
Wolfgang M. Schaefer, D. Knollmann and Philipp T. Meyer

Oncology-inspired treatment options for COVID-19  (December 2020)
NagaVaraKishore Pillarsetty, Lukas Carter, Jason S. Lewis, and Thomas Reiner

Guidance and best practices for reestablishment of non-emergent care in nuclear cardiology laboratories during the coronavirus disease 2019 (COVID-19) pandemic: An information statement from ASNC, IAEA, and SNMMI (October 2020)

Hicham Skali, Venkatesh L. Murthy, Diana Paez, Elisa M. Choi, Felix Y.J. Keng, McGhie A. Iain, Mouaz Al-Mallah, Roxana Campisi, Timothy M. Bateman, Ignasi Carrio, Rob Beanlands, Dennis A. Calnon, Vasken Dilsizian, Maurizio Dondi, Alessia Gimelli, Robert Pagnanelli, Donna M. Polk, Prem Soman, Andrew J. Einstein, Sharmila Dorbala, and Randall C. Thompson

Global Impact of COVID-19 on Nuclear Medicine Departments: An International Survey in April 2020  (September 2020)
Lutz S. Freudenberg, Diana Paez, Francesco Giammarile, Juliano Julio Cerci, Moshe Modiselle, Thomas N.B. Pascual, Noura El-Haj, Pilar Orellana, Ignasi Carrio, Stefano Fanti, Cristina Sebastiao Matushita, Yaroslav Pynda, and Ken Herrmann

The Impact of COVID‐19 on the Health‐Care Workforce: From Heroes to Zeroes? (August 2020)
Johannes Czernin

Peptide Receptor Radionuclide Therapy (PRRT) During the COVID-19 Pandemic: Are There Any Concerns?  (August 2020Lisa Bodei, Emily K. Bergsland, Wouter K. de Herder, Diego Ferone, Rodney J. Hicks, Thomas A. Hope, Jolanta A. Kunikowska, Marianne Pavel, Diane L Reidy-Lagunes, Jens Siveke, Jonathan R. Strosberg, Ulf Dittmer and Ken Herrmann

Overcoming the COVID-19 Crisis and Planning for the Future (August 2020)
Steven H LoGiudice, Allison Liebhaber, and Heiko Schöder

COVID-19 and Pulmonary Embolism: Diagnostic Imaging Trends (August 2020) 
Sedighe Karimzadeh, Akshay Raut, and Huy Nguyen Tien

Guidance and Best Practices for Nuclear Cardiology Laboratories During the Coronavirus Disease 2019 (COVID-19) Pandemic: An Information Statement from ASNC and SNMMI (June 2020)
Hicham Skali, Venkatesh L. Murthy, Mouaz H. Al-Mallah, Tim M. Bateman, Rob Beanlands, Nathan Better, Dennis A. Calnon, Vasken Dilsizian, Alessia Gimelli, Robert Pagnanelli, Donna M. Polk, Prem Soman, Randall C. Thompson, Andrew J. Einstein, and Sharmila Dorbala

Yttrium-90 Radioembolization: Telemedicine During the COVID-19 Outbreak, Opportunity for Prime Time (June 2020)
Lawrence Han Hwee Quek, Anbalagan Kannivelu, and Uei Pua

The role of Nuclear Medicine for COVID-19 – Time to Act Now (June 2020)
Freimut D Juengling, Antonio Maldonado, Frank Wuest, and Thomas Hellmut Schindler

Dr. Li Wenliang and the Time of COVID-19 (May 2020)
Johannes Czernin

Nuclear Medicine Operations in the Times of COVID-19: Strategies, Precautions and Experiences (May 2020)
Johannes Czernin, Stefano Fanti, Philipp T. Meyer, Martin Allen-Auerbach, Marcus Hacker, Mike Sathekge, Rodney Hicks, Andrew M. Scott, Jun HatazawaMijin Yun, Heiko Schöder, Peter Bartensteinand Ken Herrmann

Incidental Findings Suggestive of COVID-19 in Asymptomatic Patients Undergoing Nuclear Medicine Procedures in a High Prevalence Region (May 2020)
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Diagnostic Evaluation of Pulmonary Embolism During the COVID-19 Pandemic (May 2020)
Lionel S. Zuckier, Renée M. Moadel, Linda B. Haramati, and Leonard Freeman 


Journal of Nuclear Medicine Technology (JNMT)
 

18F-Fluciclovine Avid Axillary Lymph Nodes After COVID-19 Vaccination on PET/CT for Suspected Recurrence of Prostate Cancer (ahead of print December 2021)
Justin G Peacock, Elisabeth A Banks and Nathan E McWhorter

Lung Perfusion Scintigraphy Early After COVID-19: A Single-Center Retrospective Study (December 2021)
De Sajal, Ravina Mudalsha, Lukose Tinu, T. Ganga Ranganath and Sahu Dibakar

The Impact of Covid-19 on First Year Undergraduate Nuclear Medicine Students' Practical Skills Training (ahead of print November 2021)
Melissa Shields and Helen Warren-Forward

Reactive Axillary Lymphadenopathy to COVID-19 Vaccination on 18F-FDG PET/CT (September 2021)
Mathew V. Smith and Ming Yang

Effect of COVID-19 on 18F-FDG PET/CT: Is There a Need to Consider COVID-19 Status Before Planning 18F-FDG PET/CT for Oncologic Evaluation? (September 2021)
Anwin Joseph Kavanal, Santosh Ranjan Jena, Rajender Kumar, Chandan Krushna Das, Sunil Kumar and Bhagwant Rai Mittal

Infection Prevention in the Era of COVID-19: 2021 Basic Procedure Review (June 2021)
Barbara J. Jara

Intramuscular Injections for COVID-19 Vaccinations (Practical Protocol Tip – March 2021)
Kathy S. Thomas

COVID-19 Vaccination: An Overview and Education Tool for Nuclear Medicine Technologists (March 2021)
L. Harold Barnwell and Mark H. Crosthwaite

Guidelines on Setting Up Stations for Remote Viewing of Nuclear Medicine and Molecular Imaging Studies During COVID-19 (March 2021)
Jerold W. Wallis, Ran Klein, Tyler J. Bradshaw, Ciprian Catana, Mathieu Hatt, Richard Laforest, Chi Liu, Osama Mawlawi, Keisha C. McCall, Dustin R. Osborne, Jing Tang, R. Glenn Wells and Munir Ghesani

Nuclear Medicine Clinical Practice in the United States During the COVID-19 Era and Beyond (September 2020)
Gail A. McFarland and Sara G. Johnson

Post–COVID-19 New Normal for Molecular Imaging Departments: A United Kingdom Perspective (September 2020)
Jessica Williams, Emma Meadows, and Manrita Singh

Post–COVID-19 New Normal for Nuclear Medicine Practice: An Australasian Perspective (September 2020) 
Geoff Currie

Coronavirus (COVID-19) Pandemic: What Nuclear Medicine Departments Should Know (June 2020) 
Gopinath Gnanasegaran, Hian Liang Huang, Jessica Williams, and Jamshed Bomanji

From One Technologist to Another – COVID-19 Questions Answered (June 2020) 
Dmitry D. Beyder, Mark H. Crosthwaite, James Crowley, Lyndsi M. Hay, Kimberly Kerrylin Jackson, Nancy McDonald, Lynne T. Roy, Tricia Peters, and Nikki Wenzel-Lamb

Divide and Conquer: Strategies to Manage a Nuclear Medicine Department during COVID‐19 (June 2020)
Wei Y Tham, Aaron KT Tong, Kelvin SH Loke, Liyi Chio, Gabriel KY Lim, Xin Y Seah, David CE Ng, Sean XX Yan, Winnie WC Lam

Uptake

Lung Scintigraphy in the Era of COVID-19 and Chronic Thromboembolic Pulmonary Hypertension (May 8)
J. Anthony Parker, MD, PhD, and Kevin J. Donohoe, MD

Training and Certification

American Association of Physicists in Medicine

  • All AAPM in-person meetings, plans for AAPM funded travel and meetings of other groups at HQ are to be canceled through April 30, 2020. Find more information here.
  • Update for graduate program directors regarding recent developments in graduate medical physics education in response to the COVID-19 pandemic. (March 18)

American Board of Medical Specialties (ABMS)

  • ABMS reaffirms support for physicians to focus their priorities on patients, families, and the communities they serve. (March 26)

American Board of Nuclear Medicine (ABNM)

American Board of Radiology 

American Board of Science in Nuclear Medicine

  • The ABSNM currently plans to give the General and Specialty Examinations as scheduled on June 12, 2020 in New Orleans, Louisiana. See more updates here.

American Registry of Radiologic Technologists (ARRT)

  • ARRT COVID-19 Update: ARRT is closely monitoring the COVID-19 pandemic and how it could affect students and RTs. RTs who have questions related to their postprimary eligibility pathway requirements, renewals, CQR, or other issues should log on to their online accounts first to see if they’ve received an update specific to their concerns.  

American Society of Radiologic Technologists (ASRT)

JRCNMT

  • The JRCNMT is closely monitoring the latest information regarding the COVID-19 virus and considering its potential impact on programs and site visits. Find information here.

Nuclear Medicine Technology Certification Board (NMTCB)


Resources for Residents

Resources for Students

Government Resources

World Health Organization (WHO)

Centers for Disease Control and Prevention (CDC)

Centers for Medicare and Medicaid Services (CMS)

Department of Defense

Department of Health and Human Services (HHS) Office for Civil Rights (OCR)

Food and Drug Administration (FDA)

National Academy of Medicine (NAM)

National Cancer Institute (NCI)

National Institutes of Health (NIH)

National Science Foundation

Nuclear Regulatory Commission

Other Resources

American College of Physicians

American College of Radiology

American Medical Association

Association of American Medical Colleges

COVID-19 Data Websites

DOTmed

ECRI

Elsevier Novel Coronavirus Information Center

European Association of Nuclear Medicine (EANM)

International Atomic Energy Agency (IAEA)

MIM Software

  • During the pandemic, MIM Software is making free licenses available to its users so they can work from home. Request a license.

North American Neuroendocrine Tumor Society (NANETS)

Radiation Research Society

Radiological Society of North America (RSNA)


Sterilizing Masks for Reuse

These articles may be helpful if you need to stretch your supply of respirators. See also ECRI video above and CDC article under Government Resources tab. Please note: Several of these articles are preprints and have not yet been peer reviewed. Accordingly, they are provided for informational purposes only and should not be used to guide clinical practice.



SNMMI National Office Status

All in-person events sponsored by the society, including the SNMMI Board of Directors meeting, are now held virtually. With our extensive experience in hosting webinars and online meetings, we are confident that these virtual functions will prove both effective and engaging, furthering our goal of improving human health through nuclear medicine, molecular imaging and radionuclide therapy.

We have taken appropriate precautions to keep our leadership and staff safe. We have cancelled all non-essential travel and limited in-person meetings. Staff are working remotely, and the society remains 100% operational and ready to serve you. This means you can still access any and all online services and call or email with membership and customer service related inquiries.



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Please contact us with any issues or questions at covidhelp@snmmi.org, and we will do everything within our power to assist.