Abstract
Brain multivoxel MR spectroscopic imaging was performed in 3 consecutive patients with coronavirus disease 2019 (COVID-19). These included 1 patient with COVID-19-associated necrotizing leukoencephalopathy, another patient who had a recent pulseless electrical activity cardiac arrest with subtle white matter changes, and a patient without frank encephalopathy or a recent severe hypoxic episode. The MR spectroscopic imaging findings were compared with those of 2 patients with white matter pathology not related to Severe Acute Respiratory Syndrome coronavirus 2 infection and a healthy control subject. The NAA reduction, choline elevation, and glutamate/glutamine elevation found in the patient with COVID-19-associated necrotizing leukoencephalopathy and, to a lesser degree, the patient with COVID-19 postcardiac arrest, follow a similar pattern as seen with the patient with delayed posthypoxic leukoencephalopathy. Lactate elevation was most pronounced in the patient with COVID-19 necrotizing leukoencephalopathy.
Highlights
We present examples of MR spectra in patients with COVID-19 and compare them with both other patients with leukoencephalopathy and a control
We evaluated the metabolic differences among 3 patients with COVID-19 (1 with necrotizing leukoencephalopathy, another after cardiac arrest, and the third with mild nonspecific white matter changes without clinical encephalopathy) and other control groups with multivoxel MR spectroscopy to better understand the underlying pathophysiology of this disease
Increased Cho/Cr, decreased NAA/Cr, and increased Lac/Cr ratios were observed in the patient with COVID-19 with multifocal necrotizing leukoencephalopathy
Summary
F posthypoxic leukoencephalopathy [DPL]), TR 1⁄4 1500 ms, Number of Acquisitions 1⁄4 5, isotropic resolution 1 cc. Excitation VOIs were placed using FLAIR or T2-weighted images to include the white matter abnormalities. Of the patients with COVID-19, 1 patient had MR imaging findings compatible with a necrotizing leukoencephalopathy with abnormal reduced diffusivity and cavitation within the white matter. 1H-MR spectra from 2 non-COVID leukoencephalopathy patients, compared with a spectrum from a healthy control patient. Upper row: Axial noncontrast FLAIR (A and B) and T1-weighted (C) images at the level of the corona radiata show representative MRS voxels (black squares) from sampled periventricular regions. Lower row: Corresponding spectrum (black) and LCModel fit (red) from each patient acquired at TE = 30 ms. Choline; NAA, N-Acetyl-Aspartate; mI, Myo-Inositol; Lac, Lactate; Glx, Glutamate 1 Glutamine
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