key: cord-1014663-vxultgza
authors: van der Bijl, Pieter; Stassen, Jan; Bax, Jeroen J.
title: (18)F-FDG PET/CT for the diagnosis of aortic inflammation in COVID-19
date: 2022-05-10
journal: J Nucl Cardiol
DOI: 10.1007/s12350-022-02950-5
sha: acb5d82719e4b5ba6c882443b21005b5635ae2b8
doc_id: 1014663
cord_uid: vxultgza

nan

differed between patients and controls, in the group where scans were performed before or at 60 days after the diagnosis (P = 0.036). A fair correlation was identified between TBR and serum C-reactive protein (CRP) levels (P = 0.004), and arterial TBR was independently associated with the time from diagnosis. 3 The results therefore suggest that 18 F-FDG PET/CT can be used to diagnose and monitor large-vessel involvement in COVID-19, and that it resolves over time.

Endothelial dysfunction, including vasculitis (characterized by lymphocyte infiltration) and intravascular thrombosis, has been well documented in COVID-19. Vascular dysfunction may lead to serious complications, e.g., arterial and venous thromboses, as well as coronary and aortic dissection. 1 Large-vessel inflammation can be visualized with 18 F-FDG PET/CT, since inflammatory cells overexpress glucose transporters which avidly take up glucose and 18 F-FDG. 2 While alternative techniques are available for the diagnosis of large-vessel vasculitis, e.g., biopsy, invasive angiography, ultrasound, and magnetic resonance (MR) imaging, these are impractical (e.g., biopsy), demonstrate changes only in advanced or late-stage disease (e.g., invasive angiography), and can be non-specific (e.g., ultrasound). 2 18 F-FDG PET/CT, on the other hand, has a high sensitivity and specificity for the diagnosis of large-vessel vasculitis. 4 The uptake of 18 F-FDG into large blood vessels was correlated with acute phase reactants in a study including 26 patients with giant cell or Takayasu's arteritis-similar to the current study-suggesting that 18 F-FDG PET/CT is a sensitive technique for detecting early disease in conditions causing inflammation of large vessels. 2, 3 The presence of inflammation in large vessels has recently been demonstrated in a study of 10 patients who had recovered from acute COVID-19, but who were suffering from persistent symptoms, i.e., ''long COVID.'' 5 The current study, however, is the first to investigate the relation of large-vessel inflammation, diagnosed with 18 F-FDG PET/CT, with the time from diagnosis. 3 Early identification of the degree of vascular inflammation in COVID-19 patients might be useful in planning management. Strategies for suppression of large-vessel vasculitis in COVID-19 still have to be defined, although the use of systemic glucocorticoids appears logical, based on the beneficial effect in large-vessel vasculitides in general, as well as serious manifestations of COVID-19. 6, 7 Although the outcome implications (including the impact of the severity and duration of vascular inflammation) of large-vessel vasculitis due to COVID-19 are still unclear, the clinical use of 18 F-FDG PET/CT is promising, and the technique has been demonstrated to predict relapses in large-vessel vasculitides which were clinically in remission. 8 A confounder regarding the use of 18 F-FDG PET/CT to detect large-vessel vasculitis is the accumulation of 18 F-FDG in atherosclerotic plaques. This occurs in about 50% of all PET scans, although it can potentially be distinguished from vasculitis by the lower grade of uptake. 2, 9 Infection control protocols are also required for the performance of PET/CT scans in patients with COVID-19, which may limit its use in daily practice. An additional consideration is the fact that PET/CT involves radiation, especially when repeat scans may be required for monitoring the degree of vascular inflammation. PET/MR and novel MR contrast agents (e.g., ultrasmall superparamagnetic iron oxide) are promising alternatives for the diagnosis and prognostication of large-vessel vasculitis without the use of radiation, but their application has not been investigated in the context of COVID-19. 10 

The Department of Cardiology of Leiden University Medical Center received research grants from Abbott Vascular, Bayer, Biotronik, Bioventrix, Boston Scientific, Edwards Lifesciences, GE Healthcare and Medtronic. J.B. received speaker fees from Abbott Vascular. P.V.D.B. and J.S. have nothing to disclose.

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Time-related aortic inflammatory response, as assessed with 18F-FDG PET/CT, in patients hospitalized with severe or critical COVID-19: The COVAIR study

Management of large-vessel vasculitis with FDG-PET: A systematic literature review and meta-analysis

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

Update of the EULAR recommendations for the management of large vessel vasculitis

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