Clinical vignette

Nuclear Medicine Review 2022, 25, 2: 127–128

DOI: 10.5603/NMR.a2022.0026

Copyright © 2022 Via Medica

ISSN 1506–9680, e-ISSN 1644–4345

99mTc-Vitamin C SPECT/CT imaging in SARS-CoV-2 associated pneumonia

Haluk B. Sayman1Kubra N. Toplutas1James Tunick2Omer Aras3
1Cerrahpasa Medical Faculty, Department of Nuclear Medicine, Istanbul University-Cerrahpasa, Istanbul,Turkey
2The IMC Lab, New York, United States
3Departament of Radiology, Memorial Sloan Kettering Cancer Center, New York, United States

[Received 5 IX 2021; Accepted 5 IV 2022]

Correspondence to: Omer Aras, Departament of Radiology, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, Suite 1511, New York, NY 10065, United States, e-mail: dromeraras@gmail.com or araso@mskcc.org

This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.

We present the first 99mTc-Vitamin C single-photon emission computed tomography/computed tomography (SPECT/CT) images obtained in patients with SARS-CoV-2 (COVID-19) infection. The CT portion of SPECT/CT images showed mostly peripheral patchy and ground-glass opacities in both lungs, which are consistent with a diagnosis of SARS-CoV-2associated pneumonia in both patients. 99mTc-Vitamin C SPECT images showed increased tracer uptake corresponding to abnormal lung findings seen on CT in patient 1 who was newly diagnosed and treatment naïve. However, no abnormal uptake corresponding to lung CT findings was seen in patient 2 who received anti-SARS-CoV-2 treatment.
KEY words: 99mTc-Vitamin C; SPECT/CT; SARS-Cov-2, pneumonia
Nucl Med Rev 2022; 25, 2: 127–128

High-dose intravenous vitamin C may reduce systemic inflammation by decreasing cytokine surge and preventing lung injury in severe sepsis and acute respiratory distress syndrome [1]. It may also be beneficial in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; COVID-19) infection; we present the first lung 99mTc-Vitamin C SPECT/CT images in these patients [2]. Patient 1, a 31-year-old woman, was diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection based on a nasopharyngeal and oropharyngeal swab taken for SARS-CoV-2 during a screening, which was performed due to close contact with a positive case. She was mildly symptomatic, complaining of chest pain and cough without fever, cyanosis, clubbing, pursed lips expiration, use of accessory respiratory muscles, and nasal flaring. The patient was admitted and monitored. Results of the physical examination, including the chest examination, were unremarkable. On day 1 of admission, CT images showed mostly peripheral patchy and ground-glass opacities in both lungs (Fig. 1A: 3D colored volume-rendered images of CT, lung findings on CT, black arrows), consistent with SARS-CoV-2associated pneumonia. 99mTc-Vitamin C SPECT images showed increased tracer uptake corresponding to abnormal lung findings (fused images of SPECT/CT: top image, with physiologic blood pool uptake; bottom image, with digitally suppressed blood pool). After treatment, findings resolved with no abnormal uptake on follow-up SPECT/CT at 3 months (Fig. 1B). Patient 2, a 20-year-old woman with dry cough, and chest and muscle pain, was found positive for SARS-CoV-2 based on real-time RT-PCR testing of a nasopharyngeal swab specimen obtained on the day of admission. She had similar lung findings on CT as patient 1 although she had already been receiving standard anti-viral and anti-inflammatory treatment; however, on the 5th day of hospitalization, 99mTc-Vitamin C SPECT images showed no abnormal uptake corresponding to lung CT findings (Fig. 1C), indicating that anti-SARS-CoV-2 treatment inhibited Vitamin C uptake.

Sayman_1.jpg
Figure 1. 3D and axial CT images showed pulmonary findings consistent with SARS-CoV-2associated pneumonia in patient 1 and 99mTc-Vitamin C SPECT images showed increased tracer uptake corresponding to abnormal lung findings (A) and resolution of both CT and SPECT imaging findings on the follow-up study (B). In patient 2, 3D and axial CT images showed similar lung findings as patient 1; however, 99mTc-Vitamin C SPECT images showed no abnormal uptake corresponding to lung CT findings in patient 2 (C)

There are several cases reported of SARS-CoV-2 pneumonia and the accumulation of different nuclear medicine tracers, including 18F-FDG, 18F-Fluorocholine, 68Gal PSMA, 68Ga-DOTANOC, 99mTc-leukocyte, and 99mTc-MAA [3–8].

Vitamin C could be beneficial as a supportive treatment of sepsis and septic shock, which are common complications associated with SARS-CoV-2, by suppressing the excessive cytokine release which leads to sepsis-induced organ dysfunction and by protecting the lungs against oxidative stress. The results from these cases suggest that it could also have a detrimental effect on the SARS CoV-2 virus given its local uptake in lung lesions that are typical of SARS CoV-2 induced pneumonitis. Therefore, these cases suggest that 99mTc-Vitamin C imaging is a promising non-invasive approach to identify the presence of lung damage as well as to potentially monitor the persistence and progression of lung damage.

Conflict of interest

The authors declare no competing interests.

Funding

This research was also funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748.

References

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