Time-related aortic inflammatory response, as assessed with 18F-FDG PET/CT, in patients hospitalized with severely or critical COVID-19: the COVAIR study

Abstract

Aim Arterial involvement has been implicated in the coronavirus disease of 2019 (COVID-19). Fluorine 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) imaging is a valuable tool for the assessment of aortic inflammation and is a predictor of outcome. We sought to prospectively assess the presence of aortic inflammation and its time-dependent trend in patients with COVID-19. Methods Between November 2020 and May 2021, in this pilot, case-control study, we recruited 20 patients with severe or critical COVID-19 (mean age of 59 ± 12 years), while 10 age and sex-matched individuals served as the control group. Aortic inflammation was assessed by measuring 18 F-FDG uptake in PET/CT performed 20-120 days post-admission. Global aortic target to background ratio (GLA-TBR) was calculated as the sum of TBRs of ascending and descending aorta, aortic arch, and abdominal aorta divided by 4. Index aortic segment TBR (IAS-TBR) was designated as the aortic segment with the highest TBR. Results There was no significant difference in aortic 18 F-FDG PET/CT uptake between patients and controls (GLA-TBR: 1.46 [1.40-1.57] vs. 1.43 [1.32-1.70], respectively, P = 0.422 and IAS-TBR: 1.60 [1.50-1.67] vs. 1.50 [1.42-1.61], respectively, P = 0.155). There was a moderate correlation between aortic TBR values (both GLA and IAS) and time distance from admission to 18 F-FDG PET-CT scan (Spearman’s rho = − 0.528, P = 0.017 and Spearman’s rho = − 0.480, p = 0.032, respectively). Patients who were scanned less than or equal to 60 days from admission (n = 11) had significantly higher GLA-TBR values compared to patients that were examined more than 60 days post-admission (GLA-TBR: 1.53 [1.42-1.60] vs. 1.40 [1.33-1.45], respectively, P = 0.016 and IAS-TBR: 1.64 [1.51-1.74] vs. 1.52 [1.46-1.60], respectively, P = 0.038). There was a significant difference in IAS- TBR between patients scanned ≤ 60 days and controls (1.64 [1.51-1.74] vs. 1.50 [1.41-1.61], P = 0.036). Conclusion This is the first study suggesting that aortic inflammation, as assessed by 18 F-FDG PET/CT imaging, is increased in the early post COVID phase in patients with severe or critical COVID-19 and largely resolves over time. Our findings may have important implications for the understanding of the course of the disease and for improving our preventive and therapeutic strategies. Supplementary Information The online version contains supplementary material available at 10.1007/s12350-022-02962-1.

Oncology and cardiology positron emission tomography/computed tomography faced with COVID-19: A review of available literature data

“…Index aortic segment TBR (IASTBR) also showed a moderate association with high sensitivity CRP and days from admission to FDG PET/CT. IASTBR was significantly higher in patients scanned ≤60 days from admission than in controls, and recovered at the same level as controls at >60 days after admission for COVID-19 (68). In another report, segmental FDG uptake at the abdominal aorta was confirmed in COVID-19 patients in the early phase, and showed remission without immunosuppressive treatment 30 days later (69).…”

“…Increased PET tracer uptake in COVID-19 pneumonia has been reported in 68 Ga-PSMA (123-129), 18 F-PSMA-1007 (130) 18 F-PSMA (131), FCH (123,(132)(133)(134)(135), 68 Ga-DOTATATE (124), 68 Ga-DOTANOC (133), 68 Ga-FAPI-46 (134), 18 F-avb6-BP (136), and 82 Rb (137). 68 Ga-DOTANOC (130), FCH (123,132), and 68 Ga-PSMA (136) uptake has been reported in the mediastinum and hilar LN, suggesting a reactive response. In addition, tracheitis was diagnosed with 68 Ga-PSMA PET/CT (138).…”

“…68 Ga-DOTANOC (130), FCH (123,132), and 68 Ga-PSMA (136) uptake has been reported in the mediastinum and hilar LN, suggesting a reactive response. In addition, tracheitis was diagnosed with 68 Ga-PSMA PET/CT (138). The uptake of PSMA ligand is hypothesized to occur as a result of neovascularization and increased regional blood flow/vascular permeability, leading to the delivery of more PSMA ligand to the inflammation/infection site (139).…”

“…Examinations in the "Green" category could be rebooked without discussion with a clinician, and no PET examinations were included in this category. Those in the "Amber" category could be discussed with a clinician if there was a need to cancel/rebook, and the applicable categories were follow-up PET examination using FDG, 68 Ga-DOTATATE, 68 Ga-PSMA, and 18 F-choline (FCH). Examinations in the "Red" category could not be cancelled or rebooked unless the patient was at high risk, and the applicable categories were FDG assessment for new cancer and sepsis, 68 Ga-DOTATATE for staging and therapy decision, and 68 Ga-PSMA for new cancer (7).…”

Time-related aortic inflammatory response in severely or critical COVID-19

“…We would like to share ideas on the publication “Time-related aortic inflammatory response, as assessed with 18F-FDG PET/CT, in patients hospitalized with severely or critical COVID-19: the COVAIR study. 1 ” Aortic inflammation, as measured by 18F-FDG PET/CT imaging in patients with severe or critical COVID-19, is enhanced in the early post COVID phase and essentially decreases over time, according to Vlachopoulos et al 1 . We agree that COVID-19 may have an inflammatory alteration in the aorta.…”