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Klironomos S, Tzortzakakis A, Kits A, Öhberg C, Kollia E, Ahoromazdae A, Almqvist H, Aspelin Å, Martin H, Ouellette R, Al-Saadi J, Hasselberg M, Haghgou M, Pedersen M, Petersson S, Finnsson J, Lundberg J, Falk Delgado A, Granberg T. Nervous System Involvement in Coronavirus Disease 2019: Results from a Retrospective Consecutive Neuroimaging Cohort. Radiology 2020; 297:E324-E334. [PMID: 32729812 PMCID: PMC7393954 DOI: 10.1148/radiol.2020202791] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
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 ± 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. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
| | | | - Annika Kits
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden (S.K., A.T., A.K., C.Ö., E.K., H.A., Å.A., H.M., R.O., M.H.,M.H., M.P., J.F., J.L., A.F.D., T.G.); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (S.K., A.K., C.Ö., H.A., Å.A., R.O., J.A., M.H., J.F., J.L., A.F.D., T.G.); Department of Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden (A.T.); Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (A.A.); Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden (S.P.)
| | - Claes Öhberg
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden (S.K., A.T., A.K., C.Ö., E.K., H.A., Å.A., H.M., R.O., M.H.,M.H., M.P., J.F., J.L., A.F.D., T.G.); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (S.K., A.K., C.Ö., H.A., Å.A., R.O., J.A., M.H., J.F., J.L., A.F.D., T.G.); Department of Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden (A.T.); Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (A.A.); Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden (S.P.)
| | - Evangelia Kollia
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden (S.K., A.T., A.K., C.Ö., E.K., H.A., Å.A., H.M., R.O., M.H.,M.H., M.P., J.F., J.L., A.F.D., T.G.); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (S.K., A.K., C.Ö., H.A., Å.A., R.O., J.A., M.H., J.F., J.L., A.F.D., T.G.); Department of Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden (A.T.); Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (A.A.); Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden (S.P.)
| | - Amir Ahoromazdae
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden (S.K., A.T., A.K., C.Ö., E.K., H.A., Å.A., H.M., R.O., M.H.,M.H., M.P., J.F., J.L., A.F.D., T.G.); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (S.K., A.K., C.Ö., H.A., Å.A., R.O., J.A., M.H., J.F., J.L., A.F.D., T.G.); Department of Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden (A.T.); Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (A.A.); Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden (S.P.)
| | - Håkan Almqvist
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden (S.K., A.T., A.K., C.Ö., E.K., H.A., Å.A., H.M., R.O., M.H.,M.H., M.P., J.F., J.L., A.F.D., T.G.); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (S.K., A.K., C.Ö., H.A., Å.A., R.O., J.A., M.H., J.F., J.L., A.F.D., T.G.); Department of Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden (A.T.); Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (A.A.); Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden (S.P.)
| | - Åsa Aspelin
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden (S.K., A.T., A.K., C.Ö., E.K., H.A., Å.A., H.M., R.O., M.H.,M.H., M.P., J.F., J.L., A.F.D., T.G.); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (S.K., A.K., C.Ö., H.A., Å.A., R.O., J.A., M.H., J.F., J.L., A.F.D., T.G.); Department of Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden (A.T.); Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (A.A.); Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden (S.P.)
| | - Heather Martin
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden (S.K., A.T., A.K., C.Ö., E.K., H.A., Å.A., H.M., R.O., M.H.,M.H., M.P., J.F., J.L., A.F.D., T.G.); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (S.K., A.K., C.Ö., H.A., Å.A., R.O., J.A., M.H., J.F., J.L., A.F.D., T.G.); Department of Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden (A.T.); Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (A.A.); Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden (S.P.)
| | - Russell Ouellette
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden (S.K., A.T., A.K., C.Ö., E.K., H.A., Å.A., H.M., R.O., M.H.,M.H., M.P., J.F., J.L., A.F.D., T.G.); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (S.K., A.K., C.Ö., H.A., Å.A., R.O., J.A., M.H., J.F., J.L., A.F.D., T.G.); Department of Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden (A.T.); Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (A.A.); Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden (S.P.)
| | - Jonathan Al-Saadi
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden (S.K., A.T., A.K., C.Ö., E.K., H.A., Å.A., H.M., R.O., M.H.,M.H., M.P., J.F., J.L., A.F.D., T.G.); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (S.K., A.K., C.Ö., H.A., Å.A., R.O., J.A., M.H., J.F., J.L., A.F.D., T.G.); Department of Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden (A.T.); Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (A.A.); Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden (S.P.)
| | - Mikael Hasselberg
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden (S.K., A.T., A.K., C.Ö., E.K., H.A., Å.A., H.M., R.O., M.H.,M.H., M.P., J.F., J.L., A.F.D., T.G.); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (S.K., A.K., C.Ö., H.A., Å.A., R.O., J.A., M.H., J.F., J.L., A.F.D., T.G.); Department of Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden (A.T.); Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (A.A.); Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden (S.P.)
| | - Mansour Haghgou
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden (S.K., A.T., A.K., C.Ö., E.K., H.A., Å.A., H.M., R.O., M.H.,M.H., M.P., J.F., J.L., A.F.D., T.G.); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (S.K., A.K., C.Ö., H.A., Å.A., R.O., J.A., M.H., J.F., J.L., A.F.D., T.G.); Department of Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden (A.T.); Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (A.A.); Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden (S.P.)
| | - Mitra Pedersen
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden (S.K., A.T., A.K., C.Ö., E.K., H.A., Å.A., H.M., R.O., M.H.,M.H., M.P., J.F., J.L., A.F.D., T.G.); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (S.K., A.K., C.Ö., H.A., Å.A., R.O., J.A., M.H., J.F., J.L., A.F.D., T.G.); Department of Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden (A.T.); Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (A.A.); Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden (S.P.)
| | - Sven Petersson
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden (S.K., A.T., A.K., C.Ö., E.K., H.A., Å.A., H.M., R.O., M.H.,M.H., M.P., J.F., J.L., A.F.D., T.G.); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (S.K., A.K., C.Ö., H.A., Å.A., R.O., J.A., M.H., J.F., J.L., A.F.D., T.G.); Department of Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden (A.T.); Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (A.A.); Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden (S.P.)
| | - Johannes Finnsson
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden (S.K., A.T., A.K., C.Ö., E.K., H.A., Å.A., H.M., R.O., M.H.,M.H., M.P., J.F., J.L., A.F.D., T.G.); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (S.K., A.K., C.Ö., H.A., Å.A., R.O., J.A., M.H., J.F., J.L., A.F.D., T.G.); Department of Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden (A.T.); Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (A.A.); Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden (S.P.)
| | - Johan Lundberg
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden (S.K., A.T., A.K., C.Ö., E.K., H.A., Å.A., H.M., R.O., M.H.,M.H., M.P., J.F., J.L., A.F.D., T.G.); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (S.K., A.K., C.Ö., H.A., Å.A., R.O., J.A., M.H., J.F., J.L., A.F.D., T.G.); Department of Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden (A.T.); Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (A.A.); Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden (S.P.)
| | - Anna Falk Delgado
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden (S.K., A.T., A.K., C.Ö., E.K., H.A., Å.A., H.M., R.O., M.H.,M.H., M.P., J.F., J.L., A.F.D., T.G.); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (S.K., A.K., C.Ö., H.A., Å.A., R.O., J.A., M.H., J.F., J.L., A.F.D., T.G.); Department of Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden (A.T.); Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (A.A.); Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden (S.P.)
| | - Tobias Granberg
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden (S.K., A.T., A.K., C.Ö., E.K., H.A., Å.A., H.M., R.O., M.H.,M.H., M.P., J.F., J.L., A.F.D., T.G.); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (S.K., A.K., C.Ö., H.A., Å.A., R.O., J.A., M.H., J.F., J.L., A.F.D., T.G.); Department of Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden (A.T.); Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (A.A.); Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden (S.P.)
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