Nervous System Involvement in Coronavirus Disease 2019: Results from a Retrospective Consecutive Neuroimaging Cohort
Nervous System Involvement in Coronavirus Disease 2019: Results from a Retrospective Consecutive Neuroimaging Cohort
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DOI：
10.1148/radiol.2020202791
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发表时间：
2020-12-01
期刊：
影响因子：
19.7
通讯作者：
Granberg, Tobias
中科院分区：
文献类型：
--
作者：
Klironomos, Stefanos;Tzortzakakis, Antonios;Granberg, Tobias
工作背景：2019年冠状病毒病的神经系统并发症（COVID-19）的神经影像学表现，但对其病理生理学原因和神经解剖学相关性的认识仍然有限。目的：报告COVID-19的神经影像学表现的频率和类型。材料和方法：在这项回顾性研究中，所有严重急性呼吸综合征冠状病毒2型聚合酶链反应阳性的连续成人住院患者，卡罗林斯卡大学医院在2020年3月2日至5月24日期间被纳入其中。所有检查均由12名阅片员进行系统性重新评价。结果：共有185名COVID-19患者（62岁6 14 [标准差]; 138名男性）接受了神经影像学检查。共进行了222次脑CT、47次脑MRI和7次脊柱MRI检查。轴内易感性异常是最常见的发现（29/39; 74%，95% CI：58，87），常为提示微血管病变的卵圆形，且好发于胼胝体（23/39; 59%; 95% CI：42，74）和前皮质区（14/39; 36%; 95% CI：21，53）。还观察到缺血和大量出血的表现，但血管成像没有显示明显的异常。19例患者的动态磁敏感对比灌注MRI未显示半球或区域之间的一致不对称性。许多患者（18/41; 44%; 95% CI：28，60）有白质脑病，1例患者有胼胝体细胞毒性病变。其他发现包括嗅球信号异常（7/37; 19%）、突出的视神经蛛网膜下腔（20/36; 56%）、实质增强（3/20; 15%）、软脑膜（3/20; 15%）、颅神经（2/20; 10%）和脊神经（2/4; 50%）。在MRI随访中，分别在1例患者中观察到白质脑病和进行性软脑膜增强的消退，这提示了动态过程。结论：2019年冠状病毒病患者具有广泛的中枢和外周神经系统血管和炎症受累。(C)RSNA，2020年
Background: Neurologic complications in coronavirus disease 2019 (COVID-19) have been described, but the understanding of their pathophysiologic causes and neuroanatomical correlates remains limited.Purpose: To report on the frequency and type of neuroradiological findings in COVID-19.Materials and Methods: In this retrospective study, all consecutive adult hospitalized patients with polymerase chain reaction positivity for severe acute respiratory syndrome coronavirus 2 and who underwent neuroimaging at Karolinska University Hospital between March 2 and May 24, 2020, were included. All examinations were systematically re-evaluated by 12 readers. Summary descriptive statistics were calculated.Results: A total of 185 patients with COVID-19 (62 years 6 14 [standard deviation]; 138 men) underwent neuroimaging. In total, 222 brain CT, 47 brain MRI, and seven spinal MRI examinations were performed. Intra-axial susceptibility abnormalities were the most common finding (29 of 39; 74%, 95% CI: 58, 87) in patients who underwent brain MRI, often with an ovoid shape suggestive of microvascular pathology and with a predilection for the corpus callosum (23 of 39; 59%; 95% CI: 42, 74) and juxtacortical areas (14 of 39; 36%; 95% CI: 21, 53). Ischemic and macrohemorrhagic manifestations were also observed, but vascular imaging did not demonstrate overt abnormalities. Dynamic susceptibility contrast perfusion MRI in 19 patients did not reveal consistent asymmetries between hemispheres or regions. Many patients (18 of 41; 44%; 95% CI: 28, 60) had leukoencephalopathy and one patient had a cytotoxic lesion of the corpus callosum. Other findings included olfactory bulb signal abnormalities (seven of 37; 19%), prominent optic nerve subarachnoid spaces (20 of 36; 56%), and enhancement of the parenchyma (three of 20; 15%), leptomeninges (three of 20; 15%), cranial nerves (two of 20; 10%), and spinal nerves (two of four; 50%). At MRI follow-up, regression of leukoencephalopathy and progressive leptomeningeal enhancement was observed in one patient each, respectively, which is suggestive of dynamic processes.Conclusion: Patients with coronavirus disease 2019 had a wide spectrum of vascular and inflammatory involvement of both the central and peripheral nervous system. (C) RSNA, 2020