![Quantification of Atherosclerotic Plaque Activity and Vascular Inflammation using [18-F] Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography FDG-PET/CT](/_next/image?url=https%3A%2F%2Fcloudfront.jove.com%2FCDNSource%2Fteasers%2F3777.jpg&w=3840&q=50)
Time-related aortic inflammatory response, as assessed with 18F-FDG PET/CT, in patients hospitalized with severely or
Charalambos Vlachopoulos1, Dimitrios Terentes-Printzios2, Paraskevi Katsaounou3
11st Department of Cardiology, Athens Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Dionysiou Aiginitou 8, 11528, Athens, Greece. cvlachop@otenet.gr.
Insights
Aortic inflammation in severe COVID-19 patients, assessed by 18F-FDG PET/CT, is elevated early post-infection but resolves over time. This finding aids in understanding disease progression and refining treatment strategies.
Area of Science:
- Cardiovascular Imaging
- Infectious Disease Imaging
- Nuclear Medicine
Background:
- Arterial involvement is a known complication of COVID-19.
- 18F-FDG PET/CT is effective for evaluating aortic inflammation and predicting outcomes.
- The temporal course of aortic inflammation in COVID-19 patients requires further investigation.
Purpose of the Study:
- To prospectively assess aortic inflammation in COVID-19 patients using 18F-FDG PET/CT.
- To evaluate the time-dependent trend of aortic inflammation post-COVID-19 infection.
- To correlate imaging findings with disease severity and recovery.
Main Methods:
- A pilot case-control study included 20 severe/critical COVID-19 patients and 10 controls.
- 18F-FDG PET/CT scans were performed 20-120 days post-admission.
- Global Aortic Target-to-Background Ratio (GLA-TBR) and Index Aortic Segment TBR (IAS-TBR) were calculated to quantify inflammation.
Main Results:
- No significant difference in aortic 18F-FDG uptake between COVID-19 patients and controls.
- A moderate negative correlation was observed between aortic TBR values and time from admission.
- Patients scanned within 60 days post-admission showed significantly higher GLA-TBR and IAS-TBR compared to those scanned later and controls.
Conclusions:
- Aortic inflammation, assessed by 18F-FDG PET/CT, is elevated in the early post-COVID-19 phase for severe cases.
- Inflammation appears to largely resolve over time.
- Findings may inform strategies for managing COVID-19 cardiovascular complications.
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 18F-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 18F-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 18F-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 18F-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.
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