无症状 SARS-CoV-2 疫苗接种和未接种患者的 PET/CT 心肌 F-FDG 摄取评估。

Assessment of Myocardial F-FDG Uptake at PET/CT in Asymptomatic SARS-CoV-2-vaccinated and Nonvaccinated Patients.

机构信息

Department of Radiology, Keio University School of Medicine, Tokyo, Japan.

Advanced Clinical Research Center, Fukushima Medical University, Fukushima, Japan.

出版信息

Radiology. 2023 Sep;308(3):e230743. doi: 10.1148/radiol.230743.

DOI:10.1148/radiol.230743

PMID:37724969

Abstract

Background Patients who developed myocarditis following SARS-CoV-2 vaccination show abnormalities on cardiac MRI. However, whether myocardial changes occur in asymptomatic individuals following vaccination is not well established. Purpose To assess myocardial Fluorine-fluorodeoxyglucose (F-FDG) uptake on PET/CT in asymptomatic SARS-CoV-2 vaccinated patients compared to nonvaccinated patients. Materials and Methods This retrospective study included patients who underwent F-FDG PET/CT for indications unrelated to myocarditis during the period before (11/1/2020 - 2/16/2021) and after (2/17/20121 - 3/31/2022) SARS-CoV-2 vaccines were available. Myocardial and axillary FDG uptake were quantitatively assessed using maximum standardized uptake value (SUVmax). SUVmax values in all patients and in patients stratified by sex (male/female), age (<40, 41-60, >60 years), and time interval between vaccination and PET/CT were compared using Mann-Whitney U test or Kruskal-Wallis test with post ad -hoc Dwass, Steel, Critchlow-Fligner multiple comparison analysis. Results The study included 303 nonvaccinated patients (mean age, 52.9 years ± 14.9 [SD]; 157 females) and 700 vaccinated patients (mean age, 56.8 years ± 13.7 [SD]; 344 females). Vaccinated patients had overall higher myocardial FDG uptake compared to nonvaccinated patients (median SUVmax, 4.8 [IQR: 3.0-8.5] vs median SUVmax, 3.3 [IQR: 2.5-6.2]; < .0001). Myocardial SUVmax was higher in vaccinated patients regardless of sex (median range, 4.7-4.9 [IQR: 2.9-8.6]) or patient age (median range, 4.7-5.6 [IQR: 2.9-8.6]) compared to corresponding nonvaccinated groups (sex median range, 3.2-3.9 [IQR: 2.4-7.2]; age median range, 3.3-3.3 [IQR: 2.3-6.1]; range, <.001-.015). Furthermore, increased myocardial FDG uptake was observed in patients imaged 1-30, 31-60, 61-120, and 121-180 days after their second vaccination (median SUVmax range, 4.6-5.1 [IQR: 2.9-8.6]) and increased ipsilateral axillary uptake was observed in patients imaged 1-30, 31-60, 61-120 days after their 2nd vaccination (median SUVmax range, 1.5-2.0 [IQR: 1.2-3.4]) compared to the nonvaccinated patients ( range, <.001-<.001). Conclusion Compared to nonvaccinated patients, asymptomatic patients who received their 2nd vaccination 1-180 days prior to imaging showed increased myocardial FDG uptake on PET/CT. See also the editorial by Bluemke in this issue.

摘要

背景在接种 SARS-CoV-2 疫苗后出现心肌炎的患者在心脏 MRI 上显示异常。然而，接种疫苗后无症状个体是否会发生心肌变化尚不清楚。目的评估无症状 SARS-CoV-2 接种患者与未接种患者相比，在氟代脱氧葡萄糖（F-FDG）摄取上的正电子发射断层扫描/计算机断层扫描（PET/CT）中的心肌变化。材料和方法本回顾性研究纳入了在 SARS-CoV-2 疫苗可用之前（2020 年 11 月 1 日-2021 年 2 月 16 日）和之后（2021 年 2 月 17 日-2022 年 3 月 31 日）因与心肌炎无关的原因接受 F-FDG PET/CT 的患者。使用最大标准化摄取值（SUVmax）对心肌和腋窝 FDG 摄取进行定量评估。使用 Mann-Whitney U 检验或 Kruskal-Wallis 检验比较所有患者和按性别（男性/女性）、年龄（<40、41-60、>60 岁）和接种疫苗与 PET/CT 之间的时间间隔分层的患者的 SUVmax 值，并使用事后 Dwass、Steel、Critchlow-Fligner 多重比较分析进行比较。结果本研究纳入了 303 名未接种患者（平均年龄，52.9 岁±14.9[SD]；157 名女性）和 700 名接种患者（平均年龄，56.8 岁±13.7[SD]；344 名女性）。与未接种患者相比，接种患者的总体心肌 FDG 摄取更高（中位数 SUVmax，4.8[IQR：3.0-8.5]比中位数 SUVmax，3.3[IQR：2.5-6.2]；<.0001）。无论性别（中位数范围，4.7-4.9[IQR：2.9-8.6]）还是患者年龄（中位数范围，4.7-5.6[IQR：2.9-8.6]），接种患者的心肌 SUVmax 均高于相应的未接种组（性别中位数范围，3.2-3.9[IQR：2.4-7.2]；年龄中位数范围，3.3-3.3[IQR：2.3-6.1]；范围，<.001-.015）。此外，在接种疫苗后 1-30、31-60、61-120 和 121-180 天接受第二次接种的患者中观察到心肌 FDG 摄取增加（中位数 SUVmax 范围，4.6-5.1[IQR：2.9-8.6]），并且在接种疫苗后 1-30、31-60、61-120 天接受第二次接种的患者中观察到同侧腋窝摄取增加（中位数 SUVmax 范围，1.5-2.0[IQR：1.2-3.4]）与未接种患者相比（范围，<.001-<.001）。结论与未接种患者相比，在接受第二次接种 1-180 天前进行成像的无症状接种患者的心肌 FDG 摄取增加。另见本期 Bluemke 编辑的评论。