Lung perfusion assessment in children with long-COVID: A pilot study
Daniele Antonio Pizzuto1, Danilo Buonsenso2,3, Rosa Morello2
1Department of Radiology, Radiotherapy and Hematology, Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
Insights
This pilot study found that 42.8% of children with Long-COVID showed lung perfusion defects using 99m Tc-MAA SPECT/CT. These findings suggest potential vascular issues in pediatric Post-Covid Condition.
Area of Science:
- Pediatric Pulmonology
- Nuclear Medicine
- Infectious Diseases
Background:
- Chronic endotheliopathy may contribute to Post-Covid Condition (PCC) by impacting peripheral vascularization.
- Long-COVID in children can manifest with symptoms like chronic fatigue and postexertional malaise.
- This study investigates lung perfusion in pediatric Long-COVID patients.
Purpose of the Study:
- To assess lung perfusion in children diagnosed with Long-COVID using 99m Tc-MAA SPECT/CT.
- To explore the potential role of vascular dysfunction in pediatric PCC.
- To correlate imaging findings with clinical presentation and exercise testing results.
Main Methods:
- 99m Tc-MAA SPECT/CT was performed on children with Long-COVID and abnormal cardiopulmonary exercise testing (CPET).
- Scintigraphy followed EANM guidelines for pediatric lung scintigraphy.
- Reconstructed SPECT/CT studies were visually analyzed.
Main Results:
- 14 children (mean age 12.6 years) with Long-COVID and CPET abnormalities were included.
- Six out of 14 children (42.8%) exhibited lung perfusion defects on 99m Tc-MAA SPECT/CT.
- No morphological alterations were observed on the coregistered CT scans.
Conclusions:
- This pilot study suggests that a subgroup of children may develop lung perfusion defects post-SARS-CoV-2 infection.
- Preliminary findings indicate potential utility of 99m Tc-MAA SPECT/CT in evaluating pediatric Long-COVID.
- Larger studies are required to confirm results and guide clinical management.
Background:
There is increasing evidence that chronic endotheliopathy can play a role in patients with Post-Covid Condition (PCC, or Long Covid) by affecting peripheral vascularization. This pilot study aimed at assessing lung perfusion in children with Long-COVID with 99m Tc-MAA SPECT/CT.
Materials And Methods:
lung 99m Tc-MAA SPECT/CT was performed in children with Long-COVID and a pathological cardiopulmonary exercise testing (CPET). Intravenous injections were performed on patients in the supine position immediately before the planar scan according to the EANM guidelines for lung scintigraphy in children, followed by lung SPECT/CT acquisition. Reconstructed studies were visually analyzed.
Results:
Clinical and biochemical data were collected during acute infection and follow-up in 14 children (6 females, mean age: 12.6 years) fulfilling Long-COVID diagnostic criteria and complaining of chronic fatigue and postexertional malaise after mild efforts, documented by CPET. Imaging results were compared with clinical scenarios during acute infection and follow-up. Six out of 14 (42.8%) children showed perfusion defects on 99m Tc-MAA SPECT/CT scan, without morphological alterations on coregistered CT.
Conclusions:
This pilot investigation confirmed previous data suggesting that a small subgroup of children can develop lung perfusion defects after severe acute respiratory syndrome coronavirus 2 infection. Larger cohort studies are needed to confirm these preliminary results, providing also a better understanding of which children may deserve this test and how to manage those with lung perfusion defects.
