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European Journal of Nuclear Medicine and Molecular Imaging
Published in: European Journal of Nuclear Medicine and Molecular Imaging 10/2021

01-09-2021 | Long-COVID Syndrome | Original Article

Long COVID hallmarks on [18F]FDG-PET/CT: a case-control study

Authors: Martina Sollini, Silvia Morbelli, Michele Ciccarelli, Maurizio Cecconi, Alessio Aghemo, Paola Morelli, Silvia Chiola, Fabrizia Gelardi, Arturo Chiti

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 10/2021

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Abstract

Purpose

The present study hypothesised that whole-body [18F]FDG-PET/CT might provide insight into the pathophysiology of long COVID.

Methods

We prospectively enrolled 13 adult long COVID patients who complained for at least one persistent symptom for >30 days after infection recovery. A group of 26 melanoma patients with negative PET/CT matched for sex/age was used as controls (2:1 control to case ratio). Qualitative and semi-quantitative analysis of whole-body images was performed. Fisher exact and Mann-Whitney tests were applied to test differences between the two groups. Voxel-based analysis was performed to compare brain metabolism in cases and controls. Cases were further grouped according to prevalent symptoms and analysed accordingly.

Results

In 4/13 long COVID patients, CT images showed lung abnormalities presenting mild [18F]FDG uptake. Many healthy organs/parenchyma SUVs and SUV ratios significantly differed between the two groups (p ≤ 0.05). Long COVID patients exhibited brain hypometabolism in the right parahippocampal gyrus and thalamus (uncorrected p < 0.001 at voxel level). Specific area(s) of hypometabolism characterised patients with persistent anosmia/ageusia, fatigue, and vascular uptake (uncorrected p < 0.005 at voxel level).

Conclusion

[18F]FDG PET/CT acknowledged the multi-organ nature of long COVID, supporting the hypothesis of underlying systemic inflammation. Whole-body images showed increased [18F]FDG uptake in several “target” and “non-target” tissues. We found a typical pattern of brain hypometabolism associated with persistent complaints at the PET time, suggesting a different temporal sequence for brain and whole-body inflammatory changes. This evidence underlined the potential value of whole-body [18F]FDG PET in disclosing the pathophysiology of long COVID.
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Metadata
Title
Long COVID hallmarks on [18F]FDG-PET/CT: a case-control study
Authors
Martina Sollini
Silvia Morbelli
Michele Ciccarelli
Maurizio Cecconi
Alessio Aghemo
Paola Morelli
Silvia Chiola
Fabrizia Gelardi
Arturo Chiti
Publication date
01-09-2021
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 10/2021
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-021-05294-3

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