Abstract：
OBJECTIVE: A hypometabolic profile involving the limbic areas, brainstem and cerebellum has been identified in long COVID patients using [18F]fluorodeoxyglucose (FDG)-PET. This study was conducted to evaluate possible recovery of brain metabolism during the follow-up of patients with prolonged symptoms.
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.
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.
摘要：
目标：涉及边缘区域的低代谢分布，使用[18F]氟脱氧葡萄糖（FDG）-PET在长型COVID患者中鉴定出脑干和小脑。进行这项研究是为了评估在长期症状患者的随访期间脑代谢的可能恢复。
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。
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。
