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A comprehensive mechanism of disease remains to be elucidated. In this study we aimed to explore pulmonary and muscle fibroblast activation protein (FAP) activity in former critical COVID-19 patients with persistent dyspnea, using [\n                      <jats:sup>68<\/jats:sup>\n                      Ga]FAPI-46 PET\/CT.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this single center prospective observational study we included former critical COVID-19 patients reporting complaints of dyspnea\u2009&gt;\u20093\u00a0months after hospital discharge. A [\n                      <jats:sup>68<\/jats:sup>\n                      Ga]FAPI PET\/CT scan was performed including a high-resolution CT scan, lung function test, EQ-5D questionnaire, 6 min walking test and inflammatory markers. Age and sex-matched subjects, without pulmonary pathology, served as controls. The [\n                      <jats:sup>68<\/jats:sup>\n                      Ga]FAPI uptake was corrected for lean body mass and the target-to-background ratio (TBR) was calculated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eighteen PASC patients and 15 controls (median age 59 and 63 years and BMI of 34.6 and 25.2 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ) were included. The interval between hospital discharge and study visit was 30 months. Increased pulmonary FAP expression was observed in PASC, (TBR 0.79\u2009\u00b1\u20090.23) compared to controls (TBR 0.40\u2009\u00b1\u20090.13,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). Increased FAP expression was also observed in the paravertebral muscles (PASC: TBR 1.17 and controls TBR 1.00,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.03). Forced expiratory volume and forced vital capacity showed moderate negative correlation with the pulmonary TBR, while the percentage of ground glass opacities showed a moderate positive correlation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      [\n                      <jats:sup>68<\/jats:sup>\n                      Ga]FAPI PET\/CT demonstrated elevated FAP expression in PASC. These findings provide insight into possible pathophysiological mechanisms of PASC and a potential new diagnostic modality.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00259-025-07376-y","type":"journal-article","created":{"date-parts":[[2025,6,21]],"date-time":"2025-06-21T00:56:18Z","timestamp":1750467378000},"page":"565-573","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["[68Ga]FAPI PET\/CT reveals increased pulmonary fibroblast activation protein expression in long COVID patients after ICU discharge"],"prefix":"10.1007","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6597-205X","authenticated-orcid":false,"given":"B.","family":"van Leer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Londema","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d6.","family":"Kasalak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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The study was performed in accordance with the Declaration of Helsinki. All patients provided written informed consent.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Janesh Pillay is supported by a research grant from the Netherlands Organization for Health Research and Development, The Netherlands (ZonMw Clinical Fellowship grant 09032212110044) and has received funding from \u2018a Partnership of Siemens and UMCG for building the future of Health\u2019 (PUSH MO24.00027). The other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Riemer Slart is an associate editor for EJNMMI. Information regarding FAPI-46 precursor composition used in this study containing approximately 20% of the non-binding (R)-enantiomer was provided by GE HealthCare and incorporated in this manuscript.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}