Cardiac Imaging Assessment of Myocardial 18F-FDG Uptake at PET/CT in Asymptomatic SARS-CoV-2–vaccinated & Nonvaccinated, 2023, Takehiro Nakahara et al

Assessment of Myocardial 18F-FDG Uptake at PET/CT in Asymptomatic SARS-CoV-2–vaccinated and Nonvaccinated Patients

Authors: Takehiro Nakahara et al

Published Online: Sep 19 2023


Abstract

Background
Patients who developed myocarditis after SARS-CoV-2 vaccination show abnormalities on cardiac MRI scans. However, whether myocardial changes occur in asymptomatic individuals after vaccination is not well established.


Purpose
To assess myocardial fluorine 18 (18F) fluorodeoxyglucose (FDG) uptake on PET/CT images in asymptomatic patients vaccinated against SARS-CoV-2 compared with nonvaccinated patients.


Materials and Methods
This retrospective study included patients who underwent 18F-FDG PET/CT for indications unrelated to myocarditis during the period before (November 1, 2020, to February 16, 2021) and after (February 17, 2021, to March 31, 2022) SARS-CoV-2 vaccines were available. Myocardial and axillary 18F-FDG uptake were quantitatively assessed using maximum standardized uptake value (SUVmax). The SUVmax in all patients and in patients stratified by sex (male or female), age (<40 years, 41–60 years, >60 years), and interval between vaccination and PET/CT were compared using the Mann-Whitney U test or the 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 female, 146 male) and 700 vaccinated patients (mean age, 56.8 years ± 13.7; 344 female, 356 male).

Vaccinated patients had overall higher myocardial 18F-FDG uptake compared with nonvaccinated patients (median SUVmax, 4.8 g/mL [IQR, 3.0–8.5 g/mL] vs 3.3 g/mL [IQR, 2.5–6.2 g/mL]; P < .001).

Myocardial SUVmax was higher in vaccinated patients regardless of patient sex (median range, 4.7–4.9 g/mL [IQR, 2.9–8.6 g/mL]) or age (median range, 4.7–5.6 g/mL [IQR, 2.9–8.6 g/mL]) compared with corresponding nonvaccinated groups (sex: median range, 3.2–3.9 g/mL [IQR, 2.4–7.2 g/mL]; age: median range, 3.3–3.3 g/mL [IQR, 2.3–6.1 g/mL]; P < .001 to P = .015).

Furthermore, increased myocardial 18F-FDG uptake was observed in patients imaged 1–30, 31–60, 61–120, or 121–180 days after their second vaccination (median SUVmax range, 4.6–5.1 g/mL [IQR, 2.9–8.6 g/mL]) (P < .001 to P = .001), and increased ipsilateral axillary uptake was observed in patients imaged 1–30, 31–60, and 61–120 days after their second vaccination (median SUVmax range, 1.5–2.0 g/mL [IQR, 1.2–3.4 g/mL]) compared with the nonvaccinated patients (P < .001 to P < .001).


Conclusion
When compared with nonvaccinated patients, asymptomatic patients who received their second vaccination 1–180 days prior to imaging showed increased myocardial 18F-FDG uptake on PET/CT scans.

 

.




Summary

Asymptomatic patients who underwent PET/CT 1–180 days after their second SARS-CoV-2 vaccination showed increased myocardial fluorine 18 fluorodeoxyglucose uptake on images compared with nonvaccinated patients,

but patients imaged more than 180 days after vaccination did not


Key Results

• ■ In a retrospective study of 700 patients vaccinated against SARS-CoV-2 and 303 nonvaccinated patients who underwent PET/CT for indications other than myocarditis, patients who received their second vaccination 1–180 days before imaging showed higher myocardial fluorine 18 (18F) fluorodeoxyglucose (FDG) uptake (median standardized uptake value [SUVmax] range, 4.6–5.1 g/mL [IQR, 2.9–8.6 g/mL]) than nonvaccinated patients (median SUVmax, 3.3 g/mL [IQR, 2.5–6.2 g/mL]; range, P < .001 to P = .001).
  
  
• ■ Myocardial 18F-FDG uptake was higher in vaccinated patients regardless of sex or patient age compared with corresponding nonvaccinated groups

Introduction

While vaccines to prevent SARS-CoV-2 infection have demonstrated effectiveness in reducing morbidity and mortality related to respiratory complications (1,2), infrequent but important side effects associated with vaccination have also been reported. One such rare side effect that the mRNA vaccines have been linked to is myocarditis (3–7).

Cardiac MRI (4,7,8) and fluorine 18 (18F) fluorodeoxyglucose (FDG) PET/CT imaging (9–11) have been routinely used in the noninvasive diagnosis of myocardial inflammation of diverse origin, including viral myocarditis, cardiac sarcoidosis, and cancer therapy–related cardiac dysfunction. Good agreement has been reported between late gadolinium enhancement or T2 hyperintensity on cardiac MRI scans and 18F-FDG uptake on PET scans in patients suspected of having myocarditis (12).

A recent cardiac MRI study used late gadolinium enhancement and T2 intensity and reported myocardial injury from the SARS-CoV-2 vaccine was similar to that from myocarditis due to COVID-19, while severity was less (13). Similarly....


In conclusion

in a set of patients who underwent PET/CT for indications other than myocardial inflammation, those who had received a SARS-CoV-2 vaccine showed increased myocardial fluorine 18 (18F) fluorodeoxyglucose (FDG) uptake on images up to 180 days after their second vaccination compared with patients imaged before SARS-CoV-2 vaccination was available.

Vaccinated patients showed higher myocardial 18F-FDG uptake on PET/CT scans compared with nonvaccinated patients, regardless of sex, age, or type of mRNA vaccine received.

A prospective study would be needed to validate the findings of this study, including comparisons with cardiac enzyme levels, cardiac function, and non-mRNA vaccination.

Vaccinated patients
showed higher myocardial 18F-FDG uptake
on PET/CT scans

compared with

nonvaccinated patients,

regardless of
sex, age,
or
type of mRNA vaccine received.

 

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Does the increased uptake mean its a myocarditis ?

The study includes asymptomatic cases scanned for other reasons

I assume it was for other heart problems to check for myocardial change

This scan report says increased uptake shows myocardial change

Can I assume, for comparison, that people in similar condition show similar uptake rates, and changes, according to the condition of the heart ?

Can I assume that some body's myocardial uptake does not change much over time ?

And does not change with other circumstance ?

Not unless the heart condition changes first ?
.