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Abstract
In coronavirus disease 2019 (COVID-19), endothelial cells play a central role and an inadequate response is associated with vascular complications. PET imaging with gallium-68 labelled RGD-peptide (68Ga-RGD) targets αvβ3 integrin expression which allows quantification of endothelial activation. In this single-center, prospective observational study, we included ten hospitalized patients with COVID-19 between October 2020 and January 2021. Patients underwent 68Ga-RGD PET/CT followed by iodine mapping of lung parenchyma. CT-based segmentation of lung parenchyma, carotid arteries and myocardium was used to quantify tracer uptake by calculating standardized uptake values (SUV). Five non-COVID-19 patients were used as reference. The study population was 68.5 (IQR 52.0–74.5) years old, with median oxygen need of 3 l/min (IQR 0.9–4.0). 68Ga-RGD uptake quantified as SUV ± SD was increased in lungs (0.99 ± 0.32 vs. 0.45 ± 0.18, p < 0.01) and myocardium (3.44 ± 1.59 vs. 0.65 ± 0.22, p < 0.01) of COVID-19 patients compared to reference but not in the carotid arteries. Iodine maps showed local variations in parenchymal perfusion but no correlation with SUV. In conclusion, using 68Ga-RGD PET/CT in COVID-19 patients admitted with respiratory symptoms, we demonstrated increased endothelial activation in the lung parenchyma and myocardium. Our findings indicate the involvement of increased and localized endothelial cell activation in the cardiopulmonary system in COVID-19 patients.
Trail registration: NCT04596943.
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1 Radboud University Medical Center, Department of Medical Imaging, Nijmegen, The Netherlands (GRID:grid.10417.33) (ISNI:0000 0004 0444 9382)
2 Radboud University Medical Center, Department of Neurology, Donders Center for Medical Neurosciences, Nijmegen, The Netherlands (GRID:grid.10417.33) (ISNI:0000 0004 0444 9382)
3 Radboud University Medical Center, Department of Cardiology, Nijmegen, The Netherlands (GRID:grid.10417.33) (ISNI:0000 0004 0444 9382)
4 Radboud University Medical Center, Department of Medical Imaging, Nijmegen, The Netherlands (GRID:grid.10417.33) (ISNI:0000 0004 0444 9382); University of Twente, Faculty of Science and Technology, Enschede, The Netherlands (GRID:grid.6214.1) (ISNI:0000 0004 0399 8953)
5 Radboud University Medical Center, Department of Health Evidence, Section Biostatistics, Nijmegen, The Netherlands (GRID:grid.10417.33) (ISNI:0000 0004 0444 9382)
6 Radboud University Medical Center, Department of Respiratory Diseases, Nijmegen, The Netherlands (GRID:grid.10417.33) (ISNI:0000 0004 0444 9382)
7 Radboud University Medical Center, Department of Internal Medicine, Nijmegen, The Netherlands (GRID:grid.10417.33) (ISNI:0000 0004 0444 9382)
8 Radboud University Medical Center, Department of Respiratory Diseases, Nijmegen, The Netherlands (GRID:grid.10417.33) (ISNI:0000 0004 0444 9382); University of Bonn, Department of Immunology and Metabolism, Life and Medical Sciences Institute, Bonn, Germany (GRID:grid.10388.32) (ISNI:0000 0001 2240 3300)