Abnormal PET/MR Scans in Long COVID Patients Linked to Future Heart and Lung Disease Risk
A new study published in the July issue of The Journal of Nuclear Medicine suggests that individuals with long COVID who show abnormal findings on cardiopulmonary PET/MR scans may face a higher risk of developing cardiac and pulmonary conditions in the future. Representing the largest and longest follow-up cohort of long COVID patients with cardiopulmonary symptoms to date, the research indicates that these imaging abnormalities could serve as early warning signs, warranting closer monitoring and follow-up care.
More than 400 million people globally have been infected with COVID-19 since the start of the pandemic, including over 80 million in the United States, where around one million deaths have occurred. Long COVID—persistent symptoms lasting well beyond recovery—has emerged as a serious health concern, affecting between one-third and two-thirds of survivors months after infection.
Unfortunately, the long-term consequences of long COVID remain unknown,” said Maria Giovanna Trivieri, MD, PhD, FACC, FRCPC, associate professor of medicine and radiology at the Icahn School of Medicine, Cardiovascular Research Institute, and the Biomedical and Molecular Imaging Institute in New York. “In this study we sought to use advanced cardiopulmonary imaging to assess for evidence of cardiac and lung abnormalities, vascular injury, and inflammation in patients with long COVID.
The study enrolled 98 patients who had previously contracted COVID-19 and were still experiencing cardiopulmonary symptoms nine to 12 months after their initial infection. These individuals had clinical presentations consistent with long COVID. A control group, made up of individuals who had experienced severe COVID-19 but did not report lingering cardiopulmonary symptoms, was also included. All participants underwent 18F-FDG PET/MRI scans of the heart and lungs, as well as dual-energy CT (DECT) imaging. A subset also had their plasma proteins analyzed.
Among the long COVID group, 57% showed abnormal findings on PET/MRI scans, including uptake in the myocardium, pericardium, periannular region, and vasculature—none of which appeared in the control group’s imaging. Additionally, 90% of patients had abnormalities on DECT, such as pulmonary infiltrates and impaired perfusion.
Plasma protein analysis further distinguished long COVID patients from controls, and those with abnormal PET/MR findings showed markedly different protein profiles compared to those with normal scans. This biochemical distinction reinforced the imaging-based observations.
Over a four-year follow-up period, patients with abnormal PET/MRI findings were more likely to develop conditions such as heart failure, mitral regurgitation, and pulmonary hypertension, pointing to a strong link between early imaging abnormalities and long-term disease outcomes.
The results of the study should raise awareness in the clinicians to elicit a proper history that includes prior COVID infection and long COVID symptoms,” said Ana Devesa, MD, PhD, a former postdoctoral fellow at the Biomedical and Molecular Imaging Institute in New York and now a group leader at Spain’s Centro Nacional de Investigaciones Cardiovasculares (CNIC). “If a temporal link is identified between symptoms and timing of infection, further evaluation might be appropriate.