Enhancing Clinical Diagnosis for Patients With Persistent Pulmonary Abnormalities After COVID-19 Infection: The Potential Benefit of 68 Ga-FAPI PET/CT

Anna Sviridenko, Anna Boehm, Gianpaolo di Santo, Christian Uprimny, Bernhard Nilica, Josef Fritz, Frederik L Giesel, Uwe Haberkorn, Sabina Sahanic, Clemens Decristoforo, Ivan Tancevski, Gerlig Widmann, Judith Loeffler-Ragg, Irene Virgolini, Anna Sviridenko, Anna Boehm, Gianpaolo di Santo, Christian Uprimny, Bernhard Nilica, Josef Fritz, Frederik L Giesel, Uwe Haberkorn, Sabina Sahanic, Clemens Decristoforo, Ivan Tancevski, Gerlig Widmann, Judith Loeffler-Ragg, Irene Virgolini

Abstract

Patients and methods: Six post COVID-19 patients suspected for pulmonary fibrosis were scheduled for dual-tracer PET/CT with 18 F-FDG and 68 Ga-fibroblast activation protein inhibitor (FAPI)-46. The uptake of 68 Ga-FAPI-46 in the involved lung was compared with a control group of 9 non-COVID-19 patients. Clinical data and PET/CT imaging were collected and analyzed.

Results: PET/CT revealed in all 6 pulmonary impaired patients the reduced glucose avidity on 18 F-FDG and clear positivity on 68 Ga-FAPI-46 PET/CT in comparison to the control group.

Conclusions: Enhancing fibrotic repair mechanisms, 68 Ga-FAPI PET/CT may improve noninvasive clinical diagnostic performance in patients with long-term CT abnormalities after severe COVID-19. Although this study shows promising results, additional studies in larger populations are required to establish a general diagnostic guideline.

Trial registration: ClinicalTrials.gov NCT04416100.

Conflict of interest statement

Conflicts of interest and sources of funding: F.L.G. is an advisor at ABX, SOFIE Biosciences, and Telix Pharmaceutical. F.L.G. and U.H. have a patent application for quinolone-based FAP-targeting agents for imaging and therapy in nuclear medicine and also have shares of a consultancy group for iTheranostics. No conflicts of interest exist for A.B., A.S., S.S., G.S., J.F., C.U., B.N., I.T., G.W., I.V., and J.L.R.

Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.

Figures

FIGURE 1
FIGURE 1
Comparison of 18F-FDG PET/CT (A–C) and 68Ga-FAPI-46 PET/CT (D–F): the corresponding transaxial low-dose CT scans (A and D) and PET emission scans (B and E), together with the coronal MIPs (C and F). Showing no relevant accumulation of FDG but an accumulation of FAPI-46, 19 weeks after discharge from hospital, in residual peripheral ground-glass opacities and subtle reticular changes shown in the corresponding low dose CT scans. In addition, a serial rib fractures rights and inflammatory changes in left hip were detected on both scans.

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