Persistent Cerebral 18-FDG PET Changes in Patients With Long COVID Presenting With Fatigue and Post Exertional Malaise

Jun 8, 2026Journal of primary care & community health

Ongoing Brain Metabolism Changes in Long COVID Patients with Fatigue and Worsening Symptoms After Activity

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Abstract

Significant cerebral hypometabolism was observed in 29 patients with , particularly in the left sensorimotor cortex and bilateral primary visual cortex.

Long COVID is associated with persistent symptoms such as fatigue and , lasting up to two years after SARS-CoV-2 infection.
Cerebral hypometabolism was specifically noted in brain regions linked to motor and visual processing.
The study group consisted mainly of females (70%) with a median age of 53 years and a high prevalence of pre-existing health conditions.
Imaging findings suggest that may serve as a potential tool for diagnosing and managing long COVID.

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ObjectiveLong COVID () refers to the long-term symptoms occurring after SARS-CoV-2 infection and resolution of the initial disease prodrome. While LC is increasingly recognized, knowledge about its biomarkers is still limited. This study examines imaging findings inF-FDG PET-CT scans in 40 patients with LC from an academic LC Clinic, for potential imaging biomarkers.MethodsThis study included patients aged 18 and older with confirmed positive SARS-CoV-2 PCR test and at least 28 days post-symptom onset. scans were performed, and brain metabolic activity was compared to a control database to generate Z-scores. Participants were grouped based on their clinical phenotype and Z-scores of different brain regions were analyzed using t-tests.ResultsThe study group was mainly female (70%), with a median age of 53 years, and predominantly non-Hispanic White (90%). Most had pre-existing conditions such as gastrointestinal, cardiovascular, endocrine, and psychiatric disorders. The findings showed significant cerebral hypometabolism in 29 patients with fatigue and (PEM), particularly in the left sensorimotor cortex (p=0.0253) and bilateral primary visual cortex (right: p=0.0096, left: p=0.0016), which persisted up to two years after infection.ConclusionsIn summary, this study identified persistent cerebral hypometabolism in LC patients, especially those with fatigue with PEM, up to two years post-infection. These results suggest thatF-FDG PET-CT could be a valuable tool for diagnosing and managing LC. Further research is essential to confirm these findings and improve treatment strategies for patients with LC. 18 18 18

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29 of 40

Cerebral Hypometabolism Prevalence

Patients with exhibiting fatigue and .

Female Participants

Total participants included in the study.

53 years

Median Age

Age range of participants in the study.

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Brain scans show lasting metabolic changes in long COVID patients up to 2 years later

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Persistent Cerebral 18-FDG PET Changes in Patients With Long COVID Presenting With Fatigue and Post Exertional Malaise

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