Cerebral perfusion using ASL in patients with COVID-19 and neurological manifestations: A retrospective multicenter observational study.

Male Humans Middle Aged Spin Labels COVID-19 / complications Magnetic Resonance Imaging Perfusion Cerebrovascular Circulation

COVID-19 Cerebrovascular circulation Magnetic resonance imaging Multicenter study Neuroimaging

Journal

Journal of neuroradiology = Journal de neuroradiologie

ISSN: 0150-9861

Titre abrégé: J Neuroradiol

Pays: France

ID NLM: 7705086

Informations de publication

Date de publication:
Sep 2023

Historique:

received: 30 05 2022

revised: 15 01 2023

accepted: 15 01 2023

medline: 28 8 2023

pubmed: 20 1 2023

entrez: 19 1 2023

Statut: ppublish

Résumé

Cerebral hypoperfusion has been reported in patients with COVID-19 and neurological manifestations in small cohorts. We aimed to systematically assess changes in cerebral perfusion in a cohort of 59 of these patients, with or without abnormalities on morphological MRI sequences. Patients with biologically-confirmed COVID-19 and neurological manifestations undergoing a brain MRI with technically adequate arterial spin labeling (ASL) perfusion were included in this retrospective multicenter study. ASL maps were jointly reviewed by two readers blinded to clinical data. They assessed abnormal perfusion in four regions of interest in each brain hemisphere: frontal lobe, parietal lobe, posterior temporal lobe, and temporal pole extended to the amygdalo-hippocampal complex. Fifty-nine patients (44 men (75%), mean age 61.2 years) were included. Most patients had a severe COVID-19, 57 (97%) needed oxygen therapy and 43 (73%) were hospitalized in intensive care unit at the time of MRI. Morphological brain MRI was abnormal in 44 (75%) patients. ASL perfusion was abnormal in 53 (90%) patients, and particularly in all patients with normal morphological MRI. Hypoperfusion occurred in 48 (81%) patients, mostly in temporal poles (52 (44%)) and frontal lobes (40 (34%)). Hyperperfusion occurred in 9 (15%) patients and was closely associated with post-contrast FLAIR leptomeningeal enhancement (100% [66.4%-100%] of hyperperfusion with enhancement versus 28.6% [16.6%-43.2%] without, p = 0.002). Studied clinical parameters (especially sedation) and other morphological MRI anomalies had no significant impact on perfusion anomalies. Brain ASL perfusion showed hypoperfusion in more than 80% of patients with severe COVID-19, with or without visible lesion on conventional MRI abnormalities.

Sections du résumé

BACKGROUND AND PURPOSE OBJECTIVE

METHODS METHODS

Patients with biologically-confirmed COVID-19 and neurological manifestations undergoing a brain MRI with technically adequate arterial spin labeling (ASL) perfusion were included in this retrospective multicenter study. ASL maps were jointly reviewed by two readers blinded to clinical data. They assessed abnormal perfusion in four regions of interest in each brain hemisphere: frontal lobe, parietal lobe, posterior temporal lobe, and temporal pole extended to the amygdalo-hippocampal complex.

RESULTS RESULTS

Fifty-nine patients (44 men (75%), mean age 61.2 years) were included. Most patients had a severe COVID-19, 57 (97%) needed oxygen therapy and 43 (73%) were hospitalized in intensive care unit at the time of MRI. Morphological brain MRI was abnormal in 44 (75%) patients. ASL perfusion was abnormal in 53 (90%) patients, and particularly in all patients with normal morphological MRI. Hypoperfusion occurred in 48 (81%) patients, mostly in temporal poles (52 (44%)) and frontal lobes (40 (34%)). Hyperperfusion occurred in 9 (15%) patients and was closely associated with post-contrast FLAIR leptomeningeal enhancement (100% [66.4%-100%] of hyperperfusion with enhancement versus 28.6% [16.6%-43.2%] without, p = 0.002). Studied clinical parameters (especially sedation) and other morphological MRI anomalies had no significant impact on perfusion anomalies.

CONCLUSION CONCLUSIONS

Brain ASL perfusion showed hypoperfusion in more than 80% of patients with severe COVID-19, with or without visible lesion on conventional MRI abnormalities.

Identifiants

DOI: 10.1016/j.neurad.2023.01.005 PMID: 36657613 PMC: PMC9842391

pubmed: 36657613

pii: S0150-9861(23)00006-8

doi: 10.1016/j.neurad.2023.01.005

pmc: PMC9842391

pii:

doi:

Substances chimiques

Spin Labels 0

Types de publication

Observational Study Multicenter Study Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

470-481

Investigateurs

Fabrice Bonneville (F)

Gilles Adam (G)

Guillaume Martin-Blondel (G)

Jérémie Pariente (J)

Thomas Geeraerts (T)

Hélène Oesterlé (H)

Federico Bolognini (F)

Julien Messie (J)

Ghazi Hmeydia (G)

Joseph Benzakoun (J)

Catherine Oppenheim (C)

Jean-Marc Constans (JM)

Serge Metanbou (S)

Adrien Heintz (A)

Blanche Bapst (B)

Imen Megdiche (I)

Lavinia Jager (L)

Patrick Nesser (P)

Yannick Talla Mba (YT)

Thomas Tourdias (T)

Juliette Coutureau (J)

Céline Hemmert (C)

Philippe Feuerstein (P)

Nathan Sebag (N)

Sophie Carre (S)

Manel Alleg (M)

Claire Lecocq (C)

Emmanuel Schmitt (E)

René Anxionnat (R)

François Zhu (F)

Géraud Forestier (G)

Aymeric Rouchaud (A)

Pierre-Olivier Comby (PO)

Frederic Ricolfi (F)

Pierre Thouant (P)

Sylvie Grand (S)

Alexandre Krainik (A)

Isaure de Beaurepaire (I)

Grégoire Bornet (G)

Audrey Lacalm (A)

Patrick Miailhes (P)

Julie Pique (J)

Claire Boutet (C)

Xavier Fabre (X)

Béatrice Claise (B)

Sonia Mirafzal (S)

Laure Calvet (L)

Hubert Desal (H)

Jérome Berge (J)

Grégoire Boulouis (G)

Apolline Kazemi (A)

Nadya Pyatigorskaya (N)

Augustin Lecler (A)

Suzana Saleme (S)

Myriam Edjlali-Goujon (M)

Basile Kerleroux (B)

Jean-Christophe Brisset (JC)

Samir Chenaf (S)

Informations de copyright

Déclaration de conflit d'intérêts

Declaration of Competing Interest The 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.