Vasculitis changes in COVID-19 survivors with persistent symptoms: an [18F]FDG-PET/CT study

Abstract

Purpose Several patients experience unexplained persistent symptoms after SARS-CoV-2 recovering. We aimed at evaluating if 2-deoxy-2-[ 18 F]fluoro-D-glucose ([ 18 F]FDG) was able to demonstrate a persistent inflammatory process. Methods Recovered adult COVID-19 patients, who complained unexplained persisting symptoms for more than 30 days during the follow-up visits, were invited to participate in the study. Patients fulfilling inclusion criteria were imaged by [ 18 F]FDG positron emission tomography/computed tomography ([ 18 F]FDG-PET/CT). Whole-body [ 18 F]FDG-PET/CT, performed according to good clinical practice, was qualitatively (comparison with background/liver) and semi-quantitatively (target-to-blood pool ratio calculated as average SUVmax artery/average SUVmean inferior vena cava) analyzed. Negative follow-up [ 18 F]FDG-PET/CT images of oncologic patients matched for age/sex served as controls. Mann-Whitney test was used to test differences between groups. SPSS version 26 was used for analyses. Results Ten recovered SARS-CoV-2 patients (seven male and three females, median age 52 years, range 46–80) with persisting symptoms were enrolled in the study. Common findings at visual analysis were increased [ 18 F]FDG uptake in bone marrow and blood vessels (8/10 and 6/10 cases, respectively). [ 18 F]FDG uptake in bone marrow did not differ between cases and controls ( p = 0.16). The total vascular score was similar in the two groups ( p = 0.95). The target-to-blood pool ratio resulted higher in recovered SARS-CoV-2 patients than in controls. Conclusion Although the total vascular score was similar in the two groups, the target-to-blood pool ratio was significantly higher in three vascular regions (thoracic aorta, right iliac artery, and femoral arteries) in the recovered COVID-19 cohort than in controls, suggesting that SARS-CoV-2 induces vascular inflammation, which may be responsible for persisting symptoms.

‘Long COVID’: persistent COVID-19 symptoms in survivors managed in Lagos State, Nigeria

“…The relationship between COVID-19 severity and increased odds of persistent symptoms may be explained by the immune response to the SARS-CoV-2 virus which stimulates the production of cytokines and other inflammatory mediators, with higher concentrations found in those with a more severe clinical form [3,[26][27][28]. The multi-systemic inflammatory response to the virus may also be responsible for persistent COVID-19 symptoms in survivors [28][29][30][31].…”

<strong>Long COVID, A Comprehensive Systematic Scoping Review</strong>

“…Moreover, an astounding 78% of study subjects had abnormal cardiac MRI findings (41). Sollini and colleagues used positron emission tomography/computed tomography (PET/CT) to demonstrate that SARS-COV-2 infection could also induce vasculitis, which again was correlated with patients' prolonged symptoms (71). In a study of 538 COVID-19 survivors (median age of 52.0 years (IQR 41.0-62.0), 54.5% female) followed for median time of 97.0 (ranging from 95.0-102.0) days from discharge to first follow-up, Xiong et al found that 13% of patients complained of persistent cardiovascular symptoms (20).…”

The critical role of FDG-PET/CT imaging in assessing systemic manifestations of COVID-19 infection

“…Since patients with COVID-19 infection suffer from such vascular complications, it is likely that this imaging modality will be of great value in assessing cerebrovascular injuries. Also, it is possible that COVID-19-related vasculitis can be detected by FDG-PET imaging [29,30]. In a recent study, Sollini M et al evaluated scans of 10 Fig.…”

“…From the left to the right are the FDG-PETs 41 days after the PECCT, 47 days before, and 9 days after the positive BLE Duplex, which demonstrate improvement from 47 days before with visualization of bilateral CF and PV only, and 13 days before and 94 days after the negative BLE Duplex for acute DVT, which demonstrate progression of visualization of bilateral CF, PV, left PT, and left peroneal. BLE, bilateral lower extremities; CF, common femoral; DVT, deep vein thrombosis; PE, pulmonary embolism; PECCT, chest computed tomography with PE protocol; PT, posterior tibial; PV, popliteal vein; UE, upper extremity (reproduced with permission from Zhu HJ et al) [23] patients who had recovered from COVID-19 and assessed evidence for systemic inflammation by FDG-PET/CT imaging [30]. These investigators compared the findings in patients with those of control subjects with cancer but with negative follow-up FDG-PET/CT scans.…”

“…He developed an acute respiratory distress syndrome, which finally required endotracheal intubation and invasive ventilation. Visually, the FDG uptake was scored as grade 2 at the ascending aorta (a), the aortic arch (b), and the descending aorta (c) (reproduced with permission from Sollini M et al) [30] research for drug development for successful management of the affected population.…”