METHODS: Fifty-six adults with long COVID who underwent two brain [18F]FDG-PET scans in our department between May 2020 and October 2022 were retrospectively analysed, and compared to 51 healthy subjects. On average, PET1 was performed 7 months (range 3-17) after acute COVID-19 infection, and PET2 was performed 16 months (range 8-32) after acute infection, because of persistent severe or disabling symptoms, without significant clinical recovery. Whole-brain voxel-based analysis compared PET1 and PET2 from long COVID patients to scans from healthy subjects (p-voxel < 0.001 uncorrected, p-cluster < 0.05 FWE-corrected) and PET1 to PET2 (with the same threshold, and secondarily with a less constrained threshold of p-voxel < 0.005 uncorrected, p-cluster < 0.05 uncorrected). Additionally, a region-of-interest (ROI) semiquantitative anatomical approach was performed for the same comparisons (p < 0.05, corrected).
RESULTS: PET1 and PET2 revealed voxel-based hypometabolisms consistent with the previously reported profile in the literature. This between-group analysis comparing PET1 and PET2 showed minor improvements in the pons and cerebellum (8.4 and 5.2%, respectively, only significant under the less constrained uncorrected p-threshold); for the pons, this improvement was correlated with the PET1-PET2 interval (r = 0.21, p < 0.05). Of the 14,068 hypometabolic voxels identified on PET1, 6,503 were also hypometabolic on PET2 (46%). Of the 7,732 hypometabolic voxels identified on PET2, 6,094 were also hypometabolic on PET1 (78%). The anatomical ROI analysis confirmed the brain hypometabolism involving limbic region, the pons and cerebellum at PET1 and PET2, without significant changes between PET1 and PET2.
CONCLUSIONS: Subjects with persistent symptoms of long COVID exhibit durable deficits in brain metabolism, without progressive worsening.
方法:回顾性分析了在2020年5月至2022年10月期间在我们部门进行了两次脑[18F]FDG-PET扫描的56例长COVID成年人,并与51名健康受试者进行了比较。平均而言,PET1在急性COVID-19感染后7个月(范围3-17)进行,PET2在急性感染后16个月(范围8-32)进行,因为持续的严重或致残症状,没有明显的临床恢复。基于全脑体素的分析将长型COVID患者的PET1和PET2与健康受试者的扫描结果进行了比较(未校正的p-体素<0.001,p-cluster<0.05FWE校正)和PET1到PET2(具有相同的阈值,其次,p-体素的约束较小的阈值<0.005未校正,p簇<0.05未校正)。此外,对于相同的比较,采用感兴趣区域(ROI)半定量解剖方法(p<0.05,校正).
结果:PET1和PET2显示基于体素的低代谢,与文献中先前报道的概况一致。比较PET1和PET2的组间分析显示脑桥和小脑有轻微改善(8.4%和5.2%,分别,仅在约束较少的未校正p阈值下显著);对于脑桥,这种改善与PET1-PET2间期相关(r=0.21,p<0.05).在PET1上鉴定的14,068个低代谢体素中,有6,503个也是PET2上的低代谢体素(46%)。在PET2上鉴定的7,732个低代谢体素中,6,094个也是PET1上的低代谢体素(78%)。解剖ROI分析证实了涉及边缘区域的大脑低代谢,PET1和PET2时脑桥和小脑,PET1和PET2之间无明显变化。
结论:长期COVID症状持续的受试者表现出脑代谢的持久缺陷,没有逐渐恶化。