Incidental COVID-19 spotted on breast MR imaging, providing warning to radiologists

As radiologists tackle the massive backlog of breast imaging and other studies put on hold during the pandemic, researchers are warning them to be on the lookout for incidental COVID-19 cases.

U.K. imaging experts recently detailed these concerns in a new study, set to be published in the September issue of Radiology Case Reports. The narrow field of breast MR, in particular, includes the lungs and bony structures that must be assessed for any incidental mammary findings, noted lead author Adam Brown and colleagues.

“During the current pandemic special attention should be paid when analyzing any imaging which visualizes the lungs,” Brown and colleagues wrote. “Examples of this include breast MR, trauma imaging of the shoulder and abdominal CT or MR which includes the lung bases.”

He described the case of a 68-year-old female patient referred to the London-based Royal Free Hospital for routine mammography screening. After discovering invasive lobular breast carcinoma, clinicians performed a local staging MRI, which also pinpointed abnormal findings in the lungs.

With high prevalence of the coronavirus at the time, the team contacted the woman, who reported no symptoms. After a series of events, she ended up back at the hospital emergency room with breathlessness, undergoing a CT pulmonary angiogram, with findings further confirming the suspicion of COVID-19.

Brown and colleagues noted that MRI characteristics of the virus are less well-documented and can include nonspecific high T2-signal intensity with enhancement on post-contrast T1 imaging. They urged breast imagers to be on the lookout for these signs, especially with estimates that 30% of COVID carriers do not show outward signs of the virus.  

“Identification of these findings in asymptomatic patients allows appropriate isolation measures of patient and household contacts to be commenced to minimize further spread of the virus and also allows safety-net advice to be given to make the patient aware of any possible future deterioration,” the team concluded. “Training of radiographers to identify suspicious lung changes at the time of image acquisition can allow for appropriate cleaning of equipment and surroundings to minimize risk of infection to subsequent patients,” they added.