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Updated: May 9, 2025
Three-Dimensional Phase Resolved Functional Lung Magnetic Resonance Imaging
Published on: June 21, 2024
Prevalence of Persistent Cardiovascular and Pulmonary Abnormalities on PET/MRI and DECT Imaging in Long COVID
Maria Giovanna Trivieri1,2,3, Ana Devesa4,5, Philip M Robson2
1Icahn School of Medicine at Mount Sinai, Mount Sinai Fuster Heart Hospital, New York, New York; mariagiovanna.trivieri@mountsinai.org ana.devesa@cnic.es.
Insights
Long COVID patients show high rates of cardiopulmonary abnormalities, including inflammation in the heart and lungs, detected by advanced imaging. Peripheral biomarker differences suggest potential long-term complications requiring monitoring.
Area of Science:
- Cardiology
- Pulmonology
- Radiology
- Immunology
Background:
- Long COVID (LC) is a growing concern with persistent cardiopulmonary symptoms.
- Understanding the underlying pathophysiology of LC is crucial for patient management.
- Inflammatory changes may contribute to long-term sequelae.
Purpose of the Study:
- To determine the prevalence of inflammatory cardiopulmonary findings in patients with Long COVID.
- To investigate the utility of advanced imaging and plasma protein analysis in assessing LC-related changes.
Main Methods:
- Prospective cohort study of 98 Long COVID patients (9-12 months post-infection).
- Cardiopulmonary 18F-FDG PET/MRI and dual-energy CT (DECT) of the lungs were performed.
- Plasma protein analysis was conducted on a subgroup of patients and compared to a control group.
Main Results:
- 90% of LC patients showed DECT abnormalities (pulmonary infiltrates, abnormal perfusion).
- 57% of LC patients had abnormal PET/MRI findings, including myocarditis, pericarditis, and vascular uptake.
- Significant differences in plasma protein profiles were observed between LC patients and controls, and among LC patients with varying imaging results.
Conclusions:
- Long COVID is associated with a high prevalence of cardiopulmonary abnormalities detected by PET/MRI and DECT.
- Peripheral biomarker profiles differ significantly in LC patients, indicating systemic inflammation.
- These findings suggest the need for ongoing monitoring for potential complications like pulmonary hypertension and valvular disease.
Abstract:
The objective of this study is to describe the prevalence of inflammatory cardiopulmonary findings in a prospective cohort of long coronavirus disease (LC) patients. Methods: Subjects with a history of coronavirus disease 2019 infection, persistent cardiopulmonary symptoms 9-12 mo after initial infection, and a clinical assessment compatible with LC underwent cardiopulmonary 18F-FDG PET/MRI, dual-energy CT (DECT) of the lungs, and plasma protein analysis (subgroup). A control group that included subjects with a history of acute severe acute respiratory syndrome coronavirus 2 infection but without cardiopulmonary symptoms at recruitment was also characterized. Results: Ninety-eight patients (median age, 48.5 y; 47% men) were enrolled. The most common LC symptom was shortness of breath (80%), and 27% of participants were hospitalized. Of the subjects, 90% presented abnormalities in DECT, with 67% and 59% of participants demonstrating pulmonary infiltrates and abnormal perfusion, respectively. PET/MRI was abnormal for 57% of subjects: 24% showed cardiac involvement suggestive of myocarditis, 22% presented uptake reminiscent of pericarditis, 11% showed periannular uptake, and 30% showed vascular uptake (aortic or pulmonary). There was no myocardial, pericardial, periannular, or pulmonary uptake on the PET/MRI scans of the control group (n = 9). Analysis of plasma protein concentrations showed significant differences between the LC and the control groups. Lastly, the plasma protein profile was significantly different among LC patients with abnormal and normal PET/MRI. Conclusion: In LC subjects evaluated up to a year after coronavirus disease 2019 infection, our results indicate a high prevalence of abnormalities on PET/MRI and DECT, as well as significant differences in the peripheral biomarker profile, which might warrant further monitoring to exclude the development of complications such as pulmonary hypertension and valvular disease.
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