Retrospective Observational Study of Brain MRI Findings in Patients with Acute SARS-CoV-2 Infection and Neurologic Manifestations
Retrospective Observational Study of Brain MRI Findings in Patients with Acute SARS-CoV-2 Infection and Neurologic Manifestations
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DOI：
10.1148/radiol.2020202422
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发表时间：
2020-12-01
期刊：
影响因子：
19.7
通讯作者：
Pyatigorskaya, Nadya
中科院分区：
文献类型：
--
作者：
Chougar, Lydia;Shor, Natalia;Pyatigorskaya, Nadya
背景资料：这项研究为2019年感染冠状病毒病的大量患者提供了详细的成像评估目的：回顾性分析2019冠状病毒病（COVID-19）患者急性神经系统表现的MRI表现。材料与方法：这是一项于2020年3月23日至5月7日在巴黎地区COVID-19参考中心Pitie-Salpetriere医院进行的横断面研究。如果成人患者被诊断为严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）感染，伴有急性神经系统表现并转诊进行脑部MRI，则纳入研究。排除有神经系统疾病既往史的患者。分析不同MRI表现的特点和频率。对重症监护室（ICU）和其他科室（非ICU）患者的调查结果进行了单独分析。结果：在纳入期间，有1176名疑似COVID-19患者住院。在308例有急性神经系统症状的患者中，73例符合入选标准并被纳入（23.7%）：35例患者在ICU（47.9%），38例未在ICU（52.1%）。平均年龄为58.5岁6 15.6 [标准差]，男性占优势（65.8% vs 34.2%）。43例患者在症状发作后2-4周出现异常MRI表现其中急性缺血性脑梗死17例（23.3%），1例深静脉血栓形成（1.4%），8例有多处微血管扩张（11.3%），22例灌注异常胼胝体内弥散受限病灶3例（47.7%），符合胼胝体细胞毒性病变（4.1%）。在ICU的4名患者中观察到多灶性白色物质增强病变（5%）。在其他4例患者（5%）中观察到基底神经节异常。脑脊液分析均为阴性SARS-CoV-2在所有患者测试（n = 39）。结论：除了脑血管病变，灌注异常，胼胝体细胞毒性病变，重症监护病房相关的并发症，我们确定了两种模式，包括白色物质增强病变和基底节异常，可能与严重急性呼吸综合征冠状病毒2型感染。(C)RSNA，2020年
Background: This study provides a detailed imaging assessment in a large series of patients infected with coronavirus disease 2019 (COVID-19) and presenting with neurologic manifestations.Purpose: To review the MRI findings associated with acute neurologic manifestations in patients with COVID-19.Materials and Methods: This was a cross-sectional study conducted between March 23 and May 7, 2020, at the Pitie-Salpetriere Hospital, a reference center for COVID-19 in the Paris area. Adult patients were included if they had a diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with acute neurologic manifestations and referral for brain MRI. Patients with a prior history of neurologic disease were excluded. The characteristics and frequency of different MRI features were investigated. The findings were analyzed separately in patients in intensive care units (ICUs) and other departments (non-ICU).Results: During the inclusion period, 1176 patients suspected of having COVID-19 were hospitalized. Of 308 patients with acute neurologic symptoms, 73 met the inclusion criteria and were included (23.7%): thirty-five patients were in the ICU (47.9%) and 38 were not (52.1%). The mean age was 58.5 years 6 15.6 [standard deviation], with a male predominance (65.8% vs 34.2%). Forty-three patients had abnormal MRI findings 2-4 weeks after symptom onset (58.9%), including 17 with acute ischemic infarct (23.3%), one with a deep venous thrombosis (1.4%), eight with multiple microhemorrhages (11.3%), 22 with perfusion abnormalities (47.7%), and three with restricted diffusion foci within the corpus callosum consistent with cytotoxic lesions of the corpus callosum (4.1%). Multifocal white matter-enhancing lesions were seen in four patients in the ICU (5%). Basal ganglia abnormalities were seen in four other patients (5%). Cerebrospinal fluid analyses were negative for SARS-CoV-2 in all patients tested (n = 39).Conclusion: In addition to cerebrovascular lesions, perfusion abnormalities, cytotoxic lesions of the corpus callosum, and intensive care unit-related complications, we identified two patterns including white matter-enhancing lesions and basal ganglia abnormalities that could be related to severe acute respiratory syndrome coronavirus 2 infection. (C) RSNA, 2020