September 2020 Highlights.
September 2020 Highlights.
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2020 年 9 月亮点。
DOI：
10.1161/strokeaha.120.031895
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发表时间：
2020
期刊：
影响因子：
8.3
通讯作者：
Romero,Jose
中科院分区：
文献类型：
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作者：
Romero,Jose
Agarwal等人进行了一项回顾性研究，以描述冠状病毒病（COVID-19）和危重病患者的脑磁共振成像（MRI）特征及其与临床、实验室和功能结局的关系。2020年3月至5月期间，患者入住纽约的3家中心。在4131名COVID-19患者中，有115人接受了脑部MRI检查。其中，35例（30.4%）患者有白质脑病和脑微出血（CMB），47例（40.9%）有急性/慢性梗死、脑梗死或其他慢性发现，33例（28.7%）MRI正常。患有脑白质脑病和CMB的患者更年轻，需要更长时间的呼吸机支持，住院时间更长，血小板计数最低值更低，D-二聚体峰值和INR峰值更高，昏迷评分更差。脑MRI表现包括白质脑病（85.5%），弥散受限（53.3%），CMB（71.5%），白质脑病和CMB（57%）。80%的白质脑病为周围型，8例（33%）还显示弥散受限。脑白质病患者33.3%可见深白色物质局限性弥散。CMB多呈叶性（60%）和弥漫性（40%）。CMB常见于胼胝体（60%）和部分患者仅限于压部（16%）。在最小校正的多变量分析中，白质脑病和CMB与呼吸机天数相关。这些患者在出院时的改良兰金量表评分也较差。这项研究提供了对观察到的与COVID-19感染相关的脑成像结果的深入了解，并表明MRI标记物与COVID-19重症患者的更严重疾病和更差结局相关。参见第2649页。
Agarwal et al conducted a retrospective study to characterize the brain magnetic resonance imaging (MRI) characteristics, and relation to clinical, laboratory, and functional outcomes among patients with coronavirus disease-19 (COVID-19) and critical illness. Patients were admitted to 3 centers in New York, between March and May 2020. Out of 4131 patients with COVID-19, 115 had a brain MRI. Of these, 35 (30.4%) patients had leukoencephalopathy and cerebral microbleeds (CMB), 47 (40.9%) had acute/chronic infarcts, hemorrhages, or other chronic findings, and 33 (28.7%) had normal MRI. Patients with cerebral leukoencephalopathy and CMB were younger, required longer ventilator support, had longer hospitalizations, were thrombocytopenic with lower nadir platelet counts, higher peak D-dimer and peak INR, and had worse coma scores. Brain MRI findings included leukoencephalopathy (85.5%), restricted diffusion (53.3%), CMB (71.5%), and both leukoencephalopathy and CMB (57%). Leukoencephalopathy was perirolandic in 80% and in 8 patients (33%) also showed restricted diffusion. Deep white matter restricted diffusion was also seen 33.3% of patients with leukoencephalopathy. Most CMB were lobar (60%) and diffusely distributed (40%). CMB were frequently seen diffusely in the corpus callosum (60%) and in some patients restricted to the splenium (16%). In minimally adjusted multivariate analysis, leukoencephalopathy and CMB were associated with ventilator days. These patients also had worse modified Rankin Scale scores at discharge. This study provides insight into the brain imaging findings observed in relation to COVID-19 infection and suggests that MRI markers are related to more severe illness and worse outcomes in critically ill patients with COVID-19. See p 2649.