INCIDENTAL FINDINGS SUGGESTIVE OF COVID-19 IN ASYMPTOMATIC PATIENTS UNDERGOING NUCLEAR MEDICINE PROCEDURES IN A HIGH PREVALENCE REGION.
- 作者列表："Albano D","Bertagna F","Bertolia M","Bosio G","Lucchini S","Motta F","Panarotto MB","Peli A","Camoni L","Bengel FM","Giubbini R
:Infection with the novel coronavirus SARS-CoV-2 may remain asymptomatic, leading to under-recognition of the related disease, COVID-19, and to incidental findings in nuclear imaging procedures performed for standard clinical indications. Here, we report about our local experience in a region with high COVID-19 prevalence and dynamically increasing infection rates. Methods: Within the 8 day period of March 16-24, 2020, hybrid imaging studies of asymptomatic patients who underwent 18F-FDG-PET/CT or 131I-SPECT/CT for standard oncologic indications at our institution in Brescia, Italy, were analyzed for findings suggestive of COVID-19. Presence, radiological features and metabolic activity of interstitial pneumonia were identified, correlated with subsequent short-term clinical course and described in a case series. Results: Six of 65 patients (9%) that underwent PET/CT for various malignancies showed unexpected signs of interstitial pneumonia on CT and elevated regional FDG-avidity. Additionally, 1 of 12 patients who received radioiodine for differentiated thyroid carcinoma also showed interstitial pneumonia on SPECT/CT. 5/7 patients had subsequent proof of COVID-19 by RT-PCR. The remaining 2 patients were not tested immediately but underwent quarantine and careful monitoring. Conclusion: Incidental findings suggestive of COVID-19 may not be infrequent in hybrid imaging of asymptomatic patients, in regions with expansive spread of SARS-CoV-2. Nuclear medicine services should prepare accordingly.
: 感染新型冠状病毒的 SARS-CoV-2 可能保持无症状，导致对相关疾病的认识不足，新型冠状病毒肺炎，以及在标准临床指征进行的核成像程序中的偶然发现。在这里，我们报告了我们在一个高新型冠状病毒肺炎患病率和动态增加的感染率地区的当地经验。方法: 在 2020年3月16至24日的 8 天内，对在意大利布雷西亚我们机构接受 18F-FDG-PET/CT 或 131I-SPECT/CT 标准肿瘤适应症的无症状患者进行混合成像研究,分析结果提示新型冠状病毒肺炎。确定了间肺炎的存在、放射学特征和代谢活动，与随后的短期临床过程相关，并在病例系列中进行了描述。结果: 65 例因各种恶性肿瘤接受 PET/CT 检查的患者中有 6 例 (9%) 在 CT 上显示出意外的间肺炎征象和区域 FDG 亲和力升高。另外，12 例因分化型甲状腺癌接受放射性碘治疗的患者中，1 例在 SPECT/CT 上也显示间肺炎。5/7 例患者随后通过 RT-PCR 证明新型冠状病毒肺炎。其余 2 例患者没有立即进行检测，而是进行了检疫和仔细监测。结论: 在 SARS-CoV-2 扩张的区域，在无症状患者的混合成像中，提示新型冠状病毒肺炎的偶然发现可能并不少见。核医学服务部门应该相应地做好准备。
METHODS:BACKGROUND AND PURPOSE:A critical role for sphingosine kinase/sphingosine-1-phosphate (S1P) pathway in the control of airway function has been demonstrated in respiratory diseases. Here, we address S1P contribution in a mouse model of mild chronic obstructive pulmonary disease (COPD). EXPERIMENTAL APPROACH:C57BL/6J mice have been exposed to room air or cigarette smoke up to 11 months and killed at different time points. Functional and molecular studies have been performed. KEY RESULTS:Cigarette smoke caused emphysematous changes throughout the lung parenchyma coupled to a progressive collagen deposition in both peribronchiolar and peribronchial areas. The high and low airways showed an increased reactivity to cholinergic stimulation and α-smooth muscle actin overexpression. Similarly, an increase in airway reactivity and lung resistances following S1P challenge occurred in smoking mice. A high expression of S1P, Sph-K2 , and S1P receptors (S1P2 and S1P3 ) has been detected in the lung of smoking mice. Sphingosine kinases inhibition reversed the increased cholinergic response in airways of smoking mice. CONCLUSIONS AND IMPLICATIONS:S1P signalling up-regulation follows the disease progression in smoking mice and is involved in the development of airway hyperresponsiveness. Our study defines a therapeutic potential for S1P inhibitors in management of airways hyperresponsiveness associated to emphysema in smokers with both asthma and COPD.
METHODS::The interim results from this 90-day multi-dose, inhalation toxicology study with life-time post-exposure observation has shown an important fundamental difference in persistence and pathological response in the lung between brake dust derived from brake-pads manufactured with chrysotile, TiO2 or chrysotile alone in comparison to the amphiboles, crocidolite and amosite asbestos. In the brake dust exposure groups no significant pathological response was observed at any time. Slight macrophage accumulation of particles was noted. Wagner-scores, were from 1 to 2 (1 = air-control group) and were similar to the TiO2 group. Chrysotile being biodegradable, shows a weakening of its matrix and breaking into short fibers & particles that can be cleared by alveolar macrophages and continued dissolution. In the chrysotile exposure groups, particle laden macrophage accumulation was noted leading to a slight interstitial inflammatory response (Wagner-score 1-3). There was no peribronchiolar inflammation and occasional very slight interstitial fibrosis. The histopathology and the confocal analyses clearly differentiate the pathological response from amphibole asbestos, crocidolite and amosite, compared to that from the brake dust and chrysotile. Both crocidolite and amosite induced persistent inflammation, microgranulomas, and fibrosis (Wagner-scores 4), which persisted through the post exposure period. The confocal microscopy of the lung and snap-frozen chestwalls quantified the extensive inflammatory response and collagen development in the lung and on the visceral and parietal surfaces. The interim results reported here, provide a clear basis for differentiating the effects from brake dust exposure from those following amphibole asbestos exposure. The subsequent results through life-time post-exposure will follow.
METHODS::The respiratory tract is lined by a pseudo-stratified epithelium from the nose to terminal bronchioles. This first line of defense of the lung against external stress includes five main cell types: basal, suprabasal, club, goblet and multiciliated cells, as well as rare cells such as ionocytes, neuroendocrine and tuft/brush cells. At homeostasis, this epithelium self-renews at low rate but is able of fast regeneration upon damage. Airway epithelial cell lineages during regeneration have been investigated in the mouse by genetic labeling, mainly after injuring the epithelium with noxious agents. From these approaches, basal cells have been identified as progenitors of club, goblet and multiciliated cells, but also of ionocytes and neuroendocrine cells. Single-cell RNA sequencing, coupled to lineage inference algorithms, has independently allowed the establishment of comprehensive pictures of cell lineage relationships in both mouse and human. In line with genetic tracing experiments in mouse trachea, studies using single-cell RNA sequencing (RNAseq) have shown that basal cells first differentiate into club cells, which in turn mature into goblet cells or differentiate into multiciliated cells. In the human airway epithelium, single-cell RNAseq has identified novel intermediate populations such as deuterosomal cells, 'hybrid' mucous-multiciliated cells and progenitors of rare cells. Novel differentiation dynamics, such as a transition from goblet to multiciliated cells have also been discovered. The future of cell lineage relationships in the respiratory tract now resides in the combination of genetic labeling approaches with single-cell RNAseq to establish, in a definitive manner, the hallmarks of cellular lineages in normal and pathological situations.