18F-FDG Angiotensin-converting enzyme Anosmia COVID-19 Complaints Dysautonomia Fatigue Long COVID Memory PET SARS-CoV-2 Stress

Journal

European journal of nuclear medicine and molecular imaging
ISSN: 1619-7089
Titre abrégé: Eur J Nucl Med Mol Imaging
Pays: Germany
ID NLM: 101140988

Informations de publication

Date de publication:
08 2021
Historique:
received: 29 11 2020
accepted: 19 01 2021
pubmed: 28 1 2021
medline: 14 7 2021
entrez: 27 1 2021
Statut: ppublish

Résumé

In the context of the worldwide outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), some patients report functional complaints after apparent recovery from COVID-19. This clinical presentation has been referred as "long COVID." We here present a retrospective analysis of PET scans of 35 patients with long COVID were compared using whole-brain voxel-based analysis to a local database of 44 healthy subjects controlled for age and sex to characterize cerebral hypometabolism. The individual relevance of this metabolic profile was evaluated to classify patients and healthy subjects. Finally, the PET abnormalities were exploratory compared with the patients' characteristics and functional complaints. In comparison to healthy subjects, patients with long COVID exhibited bilateral hypometabolism in the bilateral rectal/orbital gyrus, including the olfactory gyrus; the right temporal lobe, including the amygdala and the hippocampus, extending to the right thalamus; the bilateral pons/medulla brainstem; the bilateral cerebellum (p-voxel < 0.001 uncorrected, p-cluster < 0.05 FWE-corrected). These metabolic clusters were highly discriminant to distinguish patients and healthy subjects (100% correct classification). These clusters of hypometabolism were significantly associated with more numerous functional complaints (brainstem and cerebellar clusters), and all associated with the occurrence of certain symptoms (hyposmia/anosmia, memory/cognitive impairment, pain and insomnia) (p < 0.05). In a more preliminary analysis, the metabolism of the frontal cluster which included the olfactory gyrus was worse in the 7 patients treated by ACE drugs for high blood pressure (p = 0.032), and better in the 3 patients that had used nasal decongestant spray at the infectious stage (p < 0.001). This study demonstrates a profile of brain PET hypometabolism in long COVID patients with biologically confirmed SARS-CoV-2 and persistent functional complaints more than 3 weeks after the initial infection symptoms, involving the olfactory gyrus and connected limbic/paralimbic regions, extended to the brainstem and the cerebellum. These hypometabolisms are associated with patients' symptoms, with a biomarker value to identify and potentially follow these patients. The hypometabolism of the frontal cluster, which included the olfactory gyrus, seems to be linked to ACE drugs in patients with high blood pressure, with also a better metabolism of this olfactory region in patients using nasal decongestant spray, suggesting a possible role of ACE receptors as an olfactory gateway for this neurotropism.

Identifiants

pubmed: 33501506
doi: 10.1007/s00259-021-05215-4
pii: 10.1007/s00259-021-05215-4
pmc: PMC7837643
doi:

Substances chimiques

Fluorodeoxyglucose F18 0Z5B2CJX4D

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

2823-2833

Subventions

Organisme : PHRC
ID : 07/09

Commentaires et corrections

Type : CommentIn

Références

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Auteurs

E Guedj (E)

APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, Nuclear Medicine Department, Aix-Marseille University, Marseille, France. eric.guedj@ap-hm.fr.

J Y Campion (JY)

APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, Nuclear Medicine Department, Aix-Marseille University, Marseille, France.

P Dudouet (P)

IHU-Méditerranée Infection, Marseille, France.
IRD, APHM, MEPHI, Aix-Marseille University, Marseille, France.

E Kaphan (E)

APHM, Service de Neurologie, Hôpital de la Timone, Marseille, France.

F Bregeon (F)

IHU-Méditerranée Infection, Marseille, France.
IRD, APHM, MEPHI, Aix-Marseille University, Marseille, France.
Service des Explorations Fonctionnelles Respiratoires, CHU Nord, APHM, Marseille, France.

H Tissot-Dupont (H)

IHU-Méditerranée Infection, Marseille, France.

S Guis (S)

Service de Rhumatologie, Hôpital de Sainte Marguerite, AP-HM, CNRS, CRMBM-CEMEREM, UMR CNRS 7339, Aix-Marseille Université, Marseille, France.

F Barthelemy (F)

APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, Nuclear Medicine Department, Aix-Marseille University, Marseille, France.

P Habert (P)

Radiology Department, La Timone Hospital, APHM, 264 Rue Saint Pierre, 13005, Marseille 05, France.
LIIE, Aix-Marseille University, Marseille, France.

M Ceccaldi (M)

INSERM, Inst Neurosci Syst, & APHM, Service de Neurologie et de Neuropsychologie, CHU Timone, Aix-Marseille University, Marseille, France.

M Million (M)

IHU-Méditerranée Infection, Marseille, France.
IRD, APHM, MEPHI, Aix-Marseille University, Marseille, France.

D Raoult (D)

IHU-Méditerranée Infection, Marseille, France.
IRD, APHM, MEPHI, Aix-Marseille University, Marseille, France.

S Cammilleri (S)

APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, Nuclear Medicine Department, Aix-Marseille University, Marseille, France.

C Eldin (C)

IHU-Méditerranée Infection, Marseille, France.
IRD, AP-HM, SSA, VITROME, Aix-Marseille University, Marseille, France.

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