“…Abnormalities of T2 and T1 have been noted in 0–33% and 0–5% of MIS-C patients, respectively [ 28 ••, 34 , 41 , 43 ]. Positron emission tomography (PET)/CT was also used in one patient and demonstrated evidence of acute inflammation that resolved on a later scan [ 44 ]. Fig.…”
Purpose of Review
To review the spectrum of cardiac manifestations and treatments of multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19).
Recent Findings
Studies demonstrate that up to 80% of children with MIS-C may have cardiac involvement on a spectrum of severity. Cardiac manifestations include myocarditis, coronary artery aneurysms, conduction abnormalities, and arrhythmias. Current treatments, including inotropic support, immunomodulatory therapy, and anti-coagulation, have been effective at resolving these cardiac findings in the majority of patients. COVID-19 can also cause myocarditis in the acute stage of illness and recent descriptions of COVID-19 vaccine myocarditis have occurred.
Summary
Cardiac manifestations are common in MIS-C and should be assessed for at presentation and during the clinical course as indicated.
“…Abnormalities of T2 and T1 have been noted in 0–33% and 0–5% of MIS-C patients, respectively [ 28 ••, 34 , 41 , 43 ]. Positron emission tomography (PET)/CT was also used in one patient and demonstrated evidence of acute inflammation that resolved on a later scan [ 44 ]. Fig.…”
Purpose of Review
To review the spectrum of cardiac manifestations and treatments of multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19).
Recent Findings
Studies demonstrate that up to 80% of children with MIS-C may have cardiac involvement on a spectrum of severity. Cardiac manifestations include myocarditis, coronary artery aneurysms, conduction abnormalities, and arrhythmias. Current treatments, including inotropic support, immunomodulatory therapy, and anti-coagulation, have been effective at resolving these cardiac findings in the majority of patients. COVID-19 can also cause myocarditis in the acute stage of illness and recent descriptions of COVID-19 vaccine myocarditis have occurred.
Summary
Cardiac manifestations are common in MIS-C and should be assessed for at presentation and during the clinical course as indicated.
“…18 F-FDG PET-CT, performed after 18 h of fasting and high-fat, low-carbohydrate diet preparation in a 14-year-old child with a clinical diagnosis of COVID-19-related MIS-C, demonstrated hypermetabolism in the inferolateral wall of the LV myocardium suggestive of active inflammation (Figure 4 , attached with permission). A repeat 18 F-FDG PET/CT, performed 6 wk later with the same protocol, showed resolution of hypermetabolism, consistent with clinical and biochemical improvement, thus highlighting the role of 18 F-FDG PET/CT in the timely diagnosis and follow-up of this potentially life-threatening hyperinflammatory syndrome[ 67 ].…”
Coronavirus disease 2019 (COVID-19) is caused by the novel viral pathogen, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 primarily involves the lungs. Nucleic acid testing based on reverse-transcription polymerase chain reaction of respiratory samples is the current gold standard for the diagnosis of SARS-CoV-2 infection. Imaging modalities have an established role in triaging, diagnosis, evaluation of disease severity, monitoring disease progression, extra-pulmonary involvement, and complications. As our understanding of the disease improves, there has been substantial evidence to highlight its potential for multi-systemic involvement and development of long-term sequelae. Molecular imaging techniques are highly sensitive, allowing non-invasive visualization of physiological or pathological processes at a cellular or molecular level with potential for detection of functional changes earlier than conventional radiological imaging. The purpose of this review article is to highlight the evolving role of molecular imaging in evaluation of COVID-19 sequelae. Though not ideal for diagnosis, the various modalities of molecular imaging play an important role in assessing pulmonary and extra-pulmonary sequelae of COVID-19. Perfusion imaging using single photon emission computed tomography fused with computed tomography (CT) can be utilized as a first-line imaging modality for COVID-19 related pulmonary embolism.
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F-fluorodeoxyglucose positron emission tomography (PET)/CT is a sensitive tool to detect multi-systemic inflammation, including myocardial and vascular inflammation. PET in conjunction with magnetic resonance imaging helps in better characterization of neurological sequelae of COVID-19. Despite the fact that the majority of published literature is retrospective in nature with limited sample sizes, it is clear that molecular imaging provides additional valuable information (complimentary to anatomical imaging) with semi-quantitative or quantitative parameters to define inflammatory burden and can be used to guide therapeutic strategies and assess response. However, widespread clinical applicability remains a challenge owing to longer image acquisition times and the need for adoption of infection control protocols.
“…FDG PET/CT is also widely used to assess disease extent in patients with radioiodine-refractory DTC (RR-DTC) [ 96 ]. Given limited systemic therapeutic options, multiple tracers, including radiolabeled FAPIs have been tried in progressive RR-DTC with the ultimate aim of potential theranostics [ 97 ].…”
Despite revolutionizing the field of oncological imaging, Positron Emission Tomography (PET) with [18F]Fluorodeoxyglucose (FDG) as its workhorse is limited by a lack of specificity and low sensitivity in certain tumor subtypes. Fibroblast activation protein (FAP), a type II transmembrane glycoprotein, is expressed by cancer-associated fibroblasts (CAFs) that form a major component of the tumor stroma. FAP holds the promise to be a pan-cancer target, owing to its selective over-expression in a vast majority of neoplasms, particularly epithelial cancers. Several radiolabeled FAP inhibitors (FAPI) have been developed for molecular imaging and potential theranostic applications. Preliminary data on FAPI PET/CT remains encouraging, with extensive multi-disciplinary clinical research currently underway. This review summarizes the existing literature on FAPI PET/CT imaging with an emphasis on diagnostic applications, comparison with FDG, pitfalls, and future directions.
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