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. Author manuscript; available in PMC: 2023 Jun 15.
Published in final edited form as: Nucl Med Rev Cent East Eur. 2022 Jun 14;25(2):127–128. doi: 10.5603/NMR.a2022.0026

99mTc-Vitamin C SPECT/CT Imaging in SARS-CoV-2 Associated Pneumonia

Haluk B Sayman 1,*, Kubra Nur Toplutas 1, James Tunick 2, Omer Aras 3,*
PMCID: PMC9878461  NIHMSID: NIHMS1864454  PMID: 35699590

Abstract

Here, 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-2–associated pneumonia in both patients. 99mTc-Vitamin C SPECT images showed increased tracer uptake corresponding to abnormal lung findings seen on CT in newly diagnosed and treatment naïve patient #1. However, no abnormal uptake corresponding to lung CT findings in patient #2 who had received anti SARS-CoV-2 treatment.

Keywords: 99mTc-Vitamin C, SPECT/CT, SARS-Cov-2, pneumonia

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 [2]; we present the first lung 99mTc-Vitamin C SPECT/CT images in these patients. In 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, or 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 (A: 3D colored volume rendered images of CT, lung findings on CT, black arrows), consistent with SARS-CoV-2–associated 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. In patient #2, a 20-year-old woman with dry cough, chest and muscle pain. She was found positive for SARS-CoV-2 by use of a real-time RT-PCR test after a nasopharyngeal swab was done on the day of admission. She had similar lung findings on CT as patient 1 and who had already been receiving standard anti-viral and anti-inflammatory treatments however, at 5th day of hospitalization, 99mTc-Vitamin C SPECT images showed no abnormal uptake corresponding to lung CT findings (Panel C), indicating anti SARS-CoV-2 treatment inhibiting Vitamin C uptake.

There are several cases reported of SARS-CoV-2 pneumonia with accumulation of different nuclear medicine tracers, including 18F-FDG [3], 18F-Fluorocholine [4], 68Gal PSMA [5], 68Ga-DOTANOC [6], 99mTc-leukocyte [7], and 99mTc-MAA [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 leading to sepsis-induced organ dysfunction as well as protecting lungs against oxidative stress with its antioxidant effect. The results of the studies lead us to investigate if it has detrimental effect on SARS CoV-2 virus by its local uptake in lung lesions typical for SARS CoV-2 induced pneumonitis. Therefore, these cases suggest that 99m Tc-Vitamin C imaging is a promising non-invasive approach to identify the presence and potentially monitor the persistence and progression of lung damage.

Figure 1.

Figure 1.

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3D and axial CT images showed pulmonary findings consistent with SARS-CoV-2–associated 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).

Funding Sources:

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

Footnotes

Conflict of Interest: J.T. is the CEO of the “The IMC Lab”, J.T. and O.A. are the co-founders of ImageVis LLC. The other authors declare that they have no conflict of interest.

Compliance with Ethical Standards

Informed consent: The patient was enrolled in and provided informed consent for a clinical trial that is approved by Turkey Ministry of Health for COVID related research protocol (#2020-05-14T14_56_56) at the Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty.

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