目的：动脉受累与2019年冠状病毒病（COVID-19）有关。氟18-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（18F-FDGPET/CT）成像是评估主动脉炎症的有价值的工具，并且是预后的预测指标。我们试图前瞻性评估COVID-19患者主动脉炎症的存在及其时间依赖性趋势。
方法：在2020年11月至2021年5月之间，在这个试点中，病例对照研究，我们招募了20例重症或危重症COVID-19患者（平均年龄59±12岁），而10名年龄和性别匹配的个体作为对照组。通过在入院后20-120天进行的PET/CT中测量18F-FDG摄取来评估主动脉炎症。计算总主动脉目标与背景比(GLA-TBR)为升主动脉和降主动脉的TBR之和,主动脉弓,腹主动脉除以4.索引主动脉段TBR(IAS-TBR)被指定为具有最高TBR的主动脉段。
结果：患者和对照组之间主动脉18F-FDGPET/CT摄取没有显着差异（GLA-TBR：1.46[1.40-1.57]vs.1.43[1.32-1.70],分别,P=0.422和IAS-TBR：1.60[1.50-1.67]vs.1.50[1.42-1.61],分别,P=0.155）。主动脉TBR值（GLA和IAS）与从入院到18F-FDGPET-CT扫描的时间距离之间存在中等相关性（分别为Spearman的rho=-0.528，P=0.017和Spearman的rho=-0.480，p=0.032）。与入院后60天以上检查的患者相比，入院后小于或等于60天扫描的患者（n=11）的GLA-TBR值明显更高（GLA-TBR：1.53[1.42-1.60]vs.1.40[1.33-1.45],分别,P=0.016和IAS-TBR：1.64[1.51-1.74]vs.1.52[1.46-1.60],分别,P=0.038)。扫描≤60天的患者与对照组之间的IAS-TBR存在显着差异（1.64[1.51-1.74]vs.1.50[1.41-1.61],P=0.036)。
结论：这是第一项研究表明主动脉炎症，通过18F-FDGPET/CT成像评估，严重或危重COVID-19患者在COVID后早期阶段增加，并随着时间的推移在很大程度上消退。我们的发现可能对了解疾病的过程以及改善我们的预防和治疗策略具有重要意义。
Arterial involvement has been implicated in the coronavirus disease of 2019 (COVID-19). Fluorine 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) imaging is a valuable tool for the assessment of aortic inflammation and is a predictor of outcome. We sought to prospectively assess the presence of aortic inflammation and its time-dependent trend in patients with COVID-19.
Between November 2020 and May 2021, in this pilot, case-control
study, we recruited 20 patients with severe or critical COVID-19 (mean age of 59 ± 12 years), while 10 age and sex-matched individuals served as the control group. Aortic inflammation was assessed by measuring 18F-FDG uptake in PET/CT performed 20-120 days post-admission. Global aortic target to background ratio (GLA-TBR) was calculated as the sum of TBRs of ascending and descending aorta, aortic arch, and abdominal aorta divided by 4. Index aortic segment TBR (IAS-TBR) was designated as the aortic segment with the highest TBR.
There was no significant difference in aortic 18F-FDG PET/CT uptake between patients and controls (GLA-TBR: 1.46 [1.40-1.57] vs. 1.43 [1.32-1.70], respectively, P = 0.422 and IAS-TBR: 1.60 [1.50-1.67] vs. 1.50 [1.42-1.61], respectively, P = 0.155). There was a moderate correlation between aortic TBR values (both GLA and IAS) and time distance from admission to 18F-FDG PET-CT scan (Spearman\'s rho = - 0.528, P = 0.017 and Spearman\'s rho = - 0.480, p = 0.032, respectively). Patients who were scanned less than or equal to 60 days from admission (n = 11) had significantly higher GLA-TBR values compared to patients that were examined more than 60 days post-admission (GLA-TBR: 1.53 [1.42-1.60] vs. 1.40 [1.33-1.45], respectively, P = 0.016 and IAS-TBR: 1.64 [1.51-1.74] vs. 1.52 [1.46-1.60], respectively, P = 0.038). There was a significant difference in IAS- TBR between patients scanned ≤ 60 days and controls (1.64 [1.51-1.74] vs. 1.50 [1.41-1.61], P = 0.036).
This is the first
study suggesting that aortic inflammation, as assessed by 18F-FDG PET/CT imaging, is increased in the early post COVID phase in patients with severe or critical COVID-19 and largely resolves over time. Our findings may have important implications for the understanding of the course of the disease and for improving our preventive and therapeutic strategies.
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