Relevance and Clinical Significance of Magnetic Resonance Imaging of Neurological Manifestations in COVID-19: A Systematic Review of Case Reports and Case Series.

Anisa Chowdhary,Saurabh Kataria,Roshan Subedi,Ronald Gwinn,Apoorv Prasad,Mahmoud Elkhooly,Shitiz Sriwastava,Jenil Patel,Sijin Wen,Medha Tandon,Lalit Nirwan,Sarah Peterson,Amelia Adcock

doi:10.3390/brainsci10121017

Abstract

We performed a systematic literature review of neuroimaging, predominantly focusing on magnetic resonance imaging (MRI) findings associated with neurological manifestations of coronavirus disease-2019 (COVID-19). We screened articles from PubMed, Google Scholar and Scopus, looking for reports that would potentially have neuroimaging findings in patients with COVID-19. Data analysis was performed with patient-based data based on the availability of clinical characteristics and outcomes for each individual patient from the studies. Chi square and Wilcoxon rank-sum tests were used to report COVID-19 severity and outcomes based on neurological imaging indicators and pathophysiology. A total of 171 patients with COVID-19 having neurological complications, from 134 studies, were identified in our review. The most common neuroimaging finding was ischemic stroke (62, 36.2%) cases, followed by CNS inflammatory disorder (44, 25.7%), and hemorrhagic stroke (41, 24.0%). Around 51% of all the fatal COVID-19 cases had an ischemic stroke. Among patients with ischemic stroke, the mean age of those who suffered from COVID-19 infection was 57.5 years (SD = 15.4) whereas it was 50.7 years (SD = 15.1) among those without stroke/other diagnosis. Fatality was more common in patients with ischemic stroke compared to those with other diagnosis (40% vs. 22%, p = 0.011). The most frequently published neuroimaging findings in patients with COVID-19 were ischemic stroke, CNS inflammatory disorder, and hemorrhagic disorder. In those studies, ischemic stroke was associated with fatality, and was more frequently seen in older patients. Based on our findings, early usage of MRI in COVID-19 patients may be recommended.

Highlights

The Coronavirus disease 2019 (COVID-19) outbreak began in Wuhan, China, in December 2019, and has rapidly spread around the world to be declared as a pandemic
While we reviewed findings of computed tomography (CT) scan, positron emission tomography (PET) scan and magnetic resonance imaging (MRI) scan, we only considered MRI scan findings in our analysis as it was the most commonly reported and it provided the best method of characterizing neuro-imaging findings in COVID-19 infections
Based on our search criteria, we found a total of 4465 studies from all the databases including

Summary

Introduction

The Coronavirus disease 2019 (COVID-19) outbreak began in Wuhan, China, in December 2019, and has rapidly spread around the world to be declared as a pandemic. A systematic review of studies reported that one-third of COVID-19 patients were found to have neurological manifestations [7]. Intense systemic inflammatory response can lead to eventual disruption of the blood–brain barrier (BBB) causing increased permeability to inflammatory cytokines and leading to a cascade of immune cells within the central nervous system (CNS). This is due to the underlying critical illness and systemic complications [11,12,13]. This review serves the purpose of being one of the very few literatures on the relevance and clinical importance of the neuroimaging findings in patients with COVID-19, which could be added to the database for the research to carry out further studies

Study Selection and Criteria

Data Acquisition

Data Analysis

Results

Discussion

Tables and