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Capelli S, Caroli A, Barletta A, Arrigoni A, Napolitano A, Pezzetti G, Longhi LG, Zangari R, Lorini FL, Sessa M, Remuzzi A, Gerevini S. MRI evidence of olfactory system alterations in patients with COVID-19 and neurological symptoms. J Neurol 2023; 270:1195-1206. [PMID: 36656356 PMCID: PMC9850323 DOI: 10.1007/s00415-023-11561-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/29/2022] [Accepted: 01/09/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND OBJECTIVE Despite olfactory disorders being among the most common neurological complications of coronavirus disease 2019 (COVID-19), their pathogenesis has not been fully elucidated yet. Brain MR imaging is a consolidated method for evaluating olfactory system's morphological modification, but a few quantitative studies have been published so far. The aim of the study was to provide MRI evidence of olfactory system alterations in patients with COVID-19 and neurological symptoms, including olfactory dysfunction. METHODS 196 COVID-19 patients (median age: 53 years, 56% females) and 39 controls (median age 55 years, 49% females) were included in this cross-sectional observational study; 78 of the patients reported olfactory loss as the only neurological symptom. MRI processing was performed by ad-hoc semi-automatic processing procedures. Olfactory bulb (OB) volume was measured on T2-weighted MRI based on manual tracing and normalized to the brain volume. Olfactory tract (OT) median signal intensity was quantified on fluid attenuated inversion recovery (FLAIR) sequences, after preliminary intensity normalization. RESULTS COVID-19 patients showed significantly lower left, right and total OB volumes than controls (p < 0.05). Age-related OB atrophy was found in the control but not in the patient population. No significant difference was found between patients with olfactory disorders and other neurological symptoms. Several outliers with abnormally high OT FLAIR signal intensity were found in the patient group. CONCLUSIONS Brain MRI findings demonstrated OB damage in COVID-19 patients with neurological complications. Future longitudinal studies are needed to clarify the transient or permanent nature of OB atrophy in COVID-19 pathology.
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Affiliation(s)
- Serena Capelli
- grid.4527.40000000106678902Bioengineering Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica, BG Italy
| | - Anna Caroli
- grid.4527.40000000106678902Bioengineering Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica, BG Italy
| | - Antonino Barletta
- grid.460094.f0000 0004 1757 8431Department of Neuroradiology, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
| | - Alberto Arrigoni
- grid.4527.40000000106678902Bioengineering Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica, BG Italy
| | - Angela Napolitano
- grid.460094.f0000 0004 1757 8431Department of Neuroradiology, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
| | - Giulio Pezzetti
- grid.460094.f0000 0004 1757 8431Department of Neuroradiology, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
| | - Luca Giovanni Longhi
- grid.460094.f0000 0004 1757 8431Neurosurgical Intensive Care Unit, Department of Anesthesia and Critical Care Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Rosalia Zangari
- grid.460094.f0000 0004 1757 8431FROM Research Foundation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Ferdinando Luca Lorini
- grid.460094.f0000 0004 1757 8431Department of Emergency and Critical Care Area, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Maria Sessa
- grid.460094.f0000 0004 1757 8431Department of Neurology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
| | - Andrea Remuzzi
- grid.33236.370000000106929556Department of Management, Information and Production Engineering, University of Bergamo, Dalmine, BG Italy
| | - Simonetta Gerevini
- Department of Neuroradiology, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy.
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2
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de Erausquin GA, Snyder H, Brugha TS, Seshadri S, Carrillo M, Sagar R, Huang Y, Newton C, Tartaglia C, Teunissen C, Håkanson K, Akinyemi R, Prasad K, D'Avossa G, Gonzalez‐Aleman G, Hosseini A, Vavougios GD, Sachdev P, Bankart J, Mors NPO, Lipton R, Katz M, Fox PT, Katshu MZ, Iyengar MS, Weinstein G, Sohrabi HR, Jenkins R, Stein DJ, Hugon J, Mavreas V, Blangero J, Cruchaga C, Krishna M, Wadoo O, Becerra R, Zwir I, Longstreth WT, Kroenenberg G, Edison P, Mukaetova‐Ladinska E, Staufenberg E, Figueredo‐Aguiar M, Yécora A, Vaca F, Zamponi HP, Re VL, Majid A, Sundarakumar J, Gonzalez HM, Geerlings MI, Skoog I, Salmoiraghi A, Boneschi FM, Patel VN, Santos JM, Arroyo GR, Moreno AC, Felix P, Gallo C, Arai H, Yamada M, Iwatsubo T, Sharma M, Chakraborty N, Ferreccio C, Akena D, Brayne C, Maestre G, Blangero SW, Brusco LI, Siddarth P, Hughes TM, Zuñiga AR, Kambeitz J, Laza AR, Allen N, Panos S, Merrill D, Ibáñez A, Tsuang D, Valishvili N, Shrestha S, Wang S, Padma V, Anstey KJ, Ravindrdanath V, Blennow K, Mullins P, Łojek E, Pria A, Mosley TH, Gowland P, Girard TD, Bowtell R, Vahidy FS. Chronic neuropsychiatric sequelae of SARS-CoV-2: Protocol and methods from the Alzheimer's Association Global Consortium. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2022; 8:e12348. [PMID: 36185993 PMCID: PMC9494609 DOI: 10.1002/trc2.12348] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 04/11/2022] [Accepted: 06/14/2022] [Indexed: 12/27/2022]
Abstract
Introduction Coronavirus disease 2019 (COVID-19) has caused >3.5 million deaths worldwide and affected >160 million people. At least twice as many have been infected but remained asymptomatic or minimally symptomatic. COVID-19 includes central nervous system manifestations mediated by inflammation and cerebrovascular, anoxic, and/or viral neurotoxicity mechanisms. More than one third of patients with COVID-19 develop neurologic problems during the acute phase of the illness, including loss of sense of smell or taste, seizures, and stroke. Damage or functional changes to the brain may result in chronic sequelae. The risk of incident cognitive and neuropsychiatric complications appears independent from the severity of the original pulmonary illness. It behooves the scientific and medical community to attempt to understand the molecular and/or systemic factors linking COVID-19 to neurologic illness, both short and long term. Methods This article describes what is known so far in terms of links among COVID-19, the brain, neurological symptoms, and Alzheimer's disease (AD) and related dementias. We focus on risk factors and possible molecular, inflammatory, and viral mechanisms underlying neurological injury. We also provide a comprehensive description of the Alzheimer's Association Consortium on Chronic Neuropsychiatric Sequelae of SARS-CoV-2 infection (CNS SC2) harmonized methodology to address these questions using a worldwide network of researchers and institutions. Results Successful harmonization of designs and methods was achieved through a consensus process initially fragmented by specific interest groups (epidemiology, clinical assessments, cognitive evaluation, biomarkers, and neuroimaging). Conclusions from subcommittees were presented to the whole group and discussed extensively. Presently data collection is ongoing at 19 sites in 12 countries representing Asia, Africa, the Americas, and Europe. Discussion The Alzheimer's Association Global Consortium harmonized methodology is proposed as a model to study long-term neurocognitive sequelae of SARS-CoV-2 infection. Key Points The following review describes what is known so far in terms of molecular and epidemiological links among COVID-19, the brain, neurological symptoms, and AD and related dementias (ADRD)The primary objective of this large-scale collaboration is to clarify the pathogenesis of ADRD and to advance our understanding of the impact of a neurotropic virus on the long-term risk of cognitive decline and other CNS sequelae. No available evidence supports the notion that cognitive impairment after SARS-CoV-2 infection is a form of dementia (ADRD or otherwise). The longitudinal methodologies espoused by the consortium are intended to provide data to answer this question as clearly as possible controlling for possible confounders. Our specific hypothesis is that SARS-CoV-2 triggers ADRD-like pathology following the extended olfactory cortical network (EOCN) in older individuals with specific genetic susceptibility.The proposed harmonization strategies and flexible study designs offer the possibility to include large samples of under-represented racial and ethnic groups, creating a rich set of harmonized cohorts for future studies of the pathophysiology, determinants, long-term consequences, and trends in cognitive aging, ADRD, and vascular disease.We provide a framework for current and future studies to be carried out within the Consortium. and offers a "green paper" to the research community with a very broad, global base of support, on tools suitable for low- and middle-income countries aimed to compare and combine future longitudinal data on the topic.The Consortium proposes a combination of design and statistical methods as a means of approaching causal inference of the COVID-19 neuropsychiatric sequelae. We expect that deep phenotyping of neuropsychiatric sequelae may provide a series of candidate syndromes with phenomenological and biological characterization that can be further explored. By generating high-quality harmonized data across sites we aim to capture both descriptive and, where possible, causal associations.
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Meshkov A, Khafizov A, Buzmakov A, Bukreeva I, Junemann O, Fratini M, Cedola A, Chukalina M, Yamaev A, Gigli G, Wilde F, Longo E, Asadchikov V, Saveliev S, Nikolaev D. Deep Learning-Based Segmentation of Post-Mortem Human’s Olfactory Bulb Structures in X-ray Phase-Contrast Tomography. Tomography 2022; 8:1854-1868. [PMID: 35894021 PMCID: PMC9331385 DOI: 10.3390/tomography8040156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/12/2022] [Accepted: 07/18/2022] [Indexed: 11/25/2022] Open
Abstract
The human olfactory bulb (OB) has a laminar structure. The segregation of cell populations in the OB image poses a significant challenge because of indistinct boundaries of the layers. Standard 3D visualization tools usually have a low resolution and cannot provide the high accuracy required for morphometric analysis. X-ray phase contrast tomography (XPCT) offers sufficient resolution and contrast to identify single cells in large volumes of the brain. The numerous microanatomical structures detectable in XPCT image of the OB, however, greatly complicate the manual delineation of OB neuronal cell layers. To address the challenging problem of fully automated segmentation of XPCT images of human OB morphological layers, we propose a new pipeline for tomographic data processing. Convolutional neural networks (CNN) were used to segment XPCT image of native unstained human OB. Virtual segmentation of the whole OB and an accurate delineation of each layer in a healthy non-demented OB is mandatory as the first step for assessing OB morphological changes in smell impairment research. In this framework, we proposed an effective tool that could help to shed light on OB layer-specific degeneration in patients with olfactory disorder.
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Affiliation(s)
- Alexandr Meshkov
- The Moscow Institute of Physics and Technology, 9 Institutskiy per., 141701 Moscow, Russia;
| | - Anvar Khafizov
- FSRC «Crystallography and Photonics» RAS, Leninskiy pr. 59, 119333 Moscow, Russia; (A.K.); (A.B.); (V.A.)
- Croc Inc. Company, Volochayevskaya Ulitsa 5/3, 111033 Moscow, Russia
| | - Alexey Buzmakov
- FSRC «Crystallography and Photonics» RAS, Leninskiy pr. 59, 119333 Moscow, Russia; (A.K.); (A.B.); (V.A.)
- Federal Research Center “Computer Science and Control” of the Russian Academy of Sciences, Vavilova Str. 44b2, 119333 Moscow, Russia
| | - Inna Bukreeva
- Institute of Nanotechnology—CNR, c/o Department of Physics, La Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy; (I.B.); (M.F.); (A.C.)
- P.N. Lebedev Physical Institute, RAS, Leninskiy pr. 53, 119991 Moscow, Russia
| | - Olga Junemann
- FSSI Research Institute of Human Morphology, Tsyurupy Str. 3, 117418 Moscow, Russia; (O.J.); (S.S.)
| | - Michela Fratini
- Institute of Nanotechnology—CNR, c/o Department of Physics, La Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy; (I.B.); (M.F.); (A.C.)
- IRCCS Santa Lucia Foundation, Via Ardeatina 306/354, 00142 Rome, Italy
| | - Alessia Cedola
- Institute of Nanotechnology—CNR, c/o Department of Physics, La Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy; (I.B.); (M.F.); (A.C.)
| | - Marina Chukalina
- FSRC «Crystallography and Photonics» RAS, Leninskiy pr. 59, 119333 Moscow, Russia; (A.K.); (A.B.); (V.A.)
- Smart Engines Service LLC, 60-Letiya Oktyabrya pr. 9, 117312 Moscow, Russia; (A.Y.); (D.N.)
- Institute for Information Transmission Problems of Russian Academy of Sciences (Kharkevich Institute), Bol’shoi Karetnii per. 19 Str. 1, 127051 Moscow, Russia
- Correspondence:
| | - Andrei Yamaev
- Smart Engines Service LLC, 60-Letiya Oktyabrya pr. 9, 117312 Moscow, Russia; (A.Y.); (D.N.)
| | - Giuseppe Gigli
- Institute of Nanotechnology—CNR, c/o Campus Ecotekne—Universita del Salento, Via Monteroni, 73100 Lecce, Italy;
| | - Fabian Wilde
- Institute of Materials Research, Helmholtz-Zentrum Hereon, Max-Planck-Str. 1, 21502 Geesthacht, Germany;
| | - Elena Longo
- Elettra-Sincrotrone Trieste S.C.p.A., 34149 Trieste, Italy;
| | - Victor Asadchikov
- FSRC «Crystallography and Photonics» RAS, Leninskiy pr. 59, 119333 Moscow, Russia; (A.K.); (A.B.); (V.A.)
| | - Sergey Saveliev
- FSSI Research Institute of Human Morphology, Tsyurupy Str. 3, 117418 Moscow, Russia; (O.J.); (S.S.)
| | - Dmitry Nikolaev
- Smart Engines Service LLC, 60-Letiya Oktyabrya pr. 9, 117312 Moscow, Russia; (A.Y.); (D.N.)
- Institute for Information Transmission Problems of Russian Academy of Sciences (Kharkevich Institute), Bol’shoi Karetnii per. 19 Str. 1, 127051 Moscow, Russia
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Tan CJW, Tan BKJ, Tan XY, Liu HT, Teo CB, See A, Xu S, Toh ST, Kheok SW, Charn TC, Teo NWY. Neuroradiological Basis of COVID-19 Olfactory Dysfunction: A Systematic Review and Meta-Analysis. Laryngoscope 2022; 132:1260-1274. [PMID: 35318656 PMCID: PMC9088641 DOI: 10.1002/lary.30078] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/09/2022] [Accepted: 02/14/2022] [Indexed: 12/13/2022]
Abstract
Objective Olfactory dysfunction (OD) is a common presenting symptom of COVID‐19 infection. Radiological imaging of the olfactory structures in patients with COVID‐19 and OD can potentially shed light on its pathogenesis, and guide clinicians in prognostication and intervention. Methods PubMed, Embase, Cochrane, SCOPUS were searched from inception to August 1, 2021. Three reviewers selected observational studies, case series, and case reports reporting radiological changes in the olfactory structures, detected on magnetic resonance imaging, computed tomography, or other imaging modalities, in patients aged ≥18 years with COVID‐19 infection and OD, following preferred reporting items for systematic reviews and meta‐analyses guidelines and a PROSPERO‐registered protocol (CRD42021275211). We described the proportion of radiological outcomes, and used random‐effects meta‐analyses to pool the prevalence of olfactory cleft opacification, olfactory bulb signal abnormalities, and olfactory mucosa abnormalities in patients with and without COVID‐19‐associated OD. Results We included 7 case–control studies (N = 353), 11 case series (N = 154), and 12 case reports (N = 12). The pooled prevalence of olfactory cleft opacification in patients with COVID‐19 infection and OD (63%, 95% CI = 0.38–0.82) was significantly higher than that in controls (4%, 95% CI = 0.01–0.13). Conversely, similar proportions of cases and controls demonstrated olfactory bulb signal abnormalities (88% and 94%) and olfactory mucosa abnormalities (2% and 0%). Descriptive analysis found that 55.6% and 43.5% of patients with COVID‐19 infection and OD had morphological abnormalities of the olfactory bulb and olfactory nerve, respectively, while 60.0% had abnormal olfactory bulb volumes. Conclusion Our findings implicate a conductive mechanism of OD, localized to the olfactory cleft, in approximately half of the affected COVID‐19 patients. Laryngoscope, 132:1260–1274, 2022
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Affiliation(s)
- Claire Jing-Wen Tan
- Department of Undergraduate Medicine, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Benjamin Kye Jyn Tan
- Department of Undergraduate Medicine, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Xin Yan Tan
- Department of Undergraduate Medicine, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Hui Ting Liu
- Department of Undergraduate Medicine, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Chong Boon Teo
- Department of Undergraduate Medicine, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Anna See
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital (SGH), Singapore, Singapore.,Departments of Otorhinolaryngology-Head and Neck Surgery, Sengkang General Hospital (SKH), Singapore, Singapore
| | - Shuhui Xu
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital (SGH), Singapore, Singapore
| | - Song Tar Toh
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital (SGH), Singapore, Singapore
| | - Si Wei Kheok
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore
| | - Tze Choong Charn
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital (SGH), Singapore, Singapore.,Departments of Otorhinolaryngology-Head and Neck Surgery, Sengkang General Hospital (SKH), Singapore, Singapore
| | - Neville Wei Yang Teo
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital (SGH), Singapore, Singapore
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Yildirim D, Kandemirli SG, Tekcan Sanli DE, Akinci O, Altundag A. A Comparative Olfactory MRI, DTI and fMRI Study of COVID-19 Related Anosmia and Post Viral Olfactory Dysfunction. Acad Radiol 2022; 29:31-41. [PMID: 34810059 PMCID: PMC8549400 DOI: 10.1016/j.acra.2021.10.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/15/2021] [Accepted: 10/17/2021] [Indexed: 12/24/2022]
Abstract
Rationale and Objective To evaluate how COVID-19 anosmia imaging findings resembled and differed from postinfectious olfactory dysfunction (OD). Material and Methods A total of 31 patients presenting with persistent COVID-19 related OD and 97 patients with post-infectious OD were included. Olfactory bulb MRI, DTI and olfactory fMRI findings in both groups were retrospectively assessed. Results All COVID-19 related OD cases were anosmic, 18.6% of post-infectious OD patients were hyposmic and remaining 81.4% were anosmic. Mean interval between onset of OD and imaging was 1.5 months for COVID-19 related OD and 6 months for post-infectious OD. Olfactory bulb volumes were significantly higher in COVID-19 related OD than post-infectious OD. Deformed bulb morphology and increased olfactory bulb signal intensity was seen in 58.1% and 51.6% with COVID-19 related OD; and 63.9% – 46.4% with post-infectious OD; without significant difference. Significantly higher rate of olfactory nerve clumping and higher QA values at orbitofrontal and entorhinal regions were observed in COVID-19 related OD than post-infectious OD. Absence of orbitofrontal and entorhinal activity showed no statistically significant difference between COVID-19 related OD and post-infectious OD, however trigeminosensory activity was more robust in COVID-19 related OD cases. Conclusion Olfactory bulb damage may play a central role in persistent COVID-19 related anosmia. Though there is decreased olfactory bulb volume and decreased white matter tract integrity of olfactory regions in COVID-19 related anosmia, this is not as pronounced as in other post-infectious OD. Trigeminosensory activity was more robust in COVID-19 related OD. These findings may reflect better preserved central olfactory system in COVID-19 related OD compared to COVID-19 related OD.
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Affiliation(s)
- Duzgun Yildirim
- Acibadem University, Department of Medical Imaging, Istanbul, Turkey
| | - Sedat Giray Kandemirli
- University of Iowa, Hospital and Clinics, Department of Radiology, 200 Hawkins Drive, Iowa City, IA 52242.
| | | | - Ozlem Akinci
- Sancaktepe Sehit Prof Dr Ilhan Varank Research and Training Hospital, Department of Otorhinolaryngology, Istanbul, Turkey
| | - Aytug Altundag
- Acibadem Taksim Hospital, Department of Otorhinolaryngology, Istanbul, Turkey
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Kremer S, Gerevini S, Ramos A, Lersy F, Yousry T, Vernooij MW, Anzalone N, Jäger HR. Neuroimaging in patients with COVID-19: a neuroradiology expert group consensus. Eur Radiol 2022; 32:3716-3725. [PMID: 35044509 PMCID: PMC8766353 DOI: 10.1007/s00330-021-08499-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/27/2021] [Accepted: 11/30/2021] [Indexed: 02/06/2023]
Abstract
Neurological and neuroradiological manifestations in patients with COVID-19 have been extensively reported. Available imaging data are, however, very heterogeneous. Hence, there is a growing need to standardise clinical indications for neuroimaging, MRI acquisition protocols, and necessity of follow-up examinations. A NeuroCovid working group with experts in the field of neuroimaging in COVID-19 has been constituted under the aegis of the Subspecialty Committee on Diagnostic Neuroradiology of the European Society of Neuroradiology (ESNR). The initial objectives of this NeuroCovid working group are to address the standardisation of the imaging in patients with neurological manifestations of COVID-19 and to give advice based on expert opinion with the aim of improving the quality of patient care and ensure high quality of any future clinical studies. KEY POINTS: • In patients with COVID-19 and neurological manifestations, neuroimaging should be performed in order to detect underlying causal pathology. • The basic MRI recommended protocol includes T2-weighted, FLAIR (preferably 3D), and diffusion-weighted images, as well as haemorrhage-sensitive sequence (preferably SWI), and at least for the initial investigation pre and post-contrast T1 weighted-images. • 3D FLAIR should be acquired after gadolinium administration in order to optimise the detection of leptomeningeal contrast enhancement.
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Affiliation(s)
- Stéphane Kremer
- Hôpitaux Universitaires de Strasbourg, Service d'imagerie 2, Hôpital de Hautepierre, Strasbourg, France.
- Engineering Science, Computer Science and Imaging Laboratory (ICube), Integrative Multimodal Imaging in Healthcare, UMR 7357, University of Strasbourg-CNRS, Strasbourg, France.
| | | | - Ana Ramos
- Sección de Neurorradiología, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - François Lersy
- Hôpitaux Universitaires de Strasbourg, Service d'imagerie 2, Hôpital de Hautepierre, Strasbourg, France
| | - Tarek Yousry
- Neuroradiological Academic Unit, Queen Square UCL Institute of Neurology, London, Great Britain
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, London, Great Britain
| | - Meike W Vernooij
- Department of Radiology & Nuclear Medicine, Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Nicoletta Anzalone
- Department of Neuroradiology, IRCCS San Raffaele, Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy
| | - Hans Rolf Jäger
- Neuroradiological Academic Unit, Queen Square UCL Institute of Neurology, London, Great Britain
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, London, Great Britain
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7
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Griffanti L, Raman B, Alfaro-Almagro F, Filippini N, Cassar MP, Sheerin F, Okell TW, Kennedy McConnell FA, Chappell MA, Wang C, Arthofer C, Lange FJ, Andersson J, Mackay CE, Tunnicliffe EM, Rowland M, Neubauer S, Miller KL, Jezzard P, Smith SM. Adapting the UK Biobank Brain Imaging Protocol and Analysis Pipeline for the C-MORE Multi-Organ Study of COVID-19 Survivors. Front Neurol 2021; 12:753284. [PMID: 34777224 PMCID: PMC8586081 DOI: 10.3389/fneur.2021.753284] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/06/2021] [Indexed: 01/08/2023] Open
Abstract
SARS-CoV-2 infection has been shown to damage multiple organs, including the brain. Multiorgan MRI can provide further insight on the repercussions of COVID-19 on organ health but requires a balance between richness and quality of data acquisition and total scan duration. We adapted the UK Biobank brain MRI protocol to produce high-quality images while being suitable as part of a post-COVID-19 multiorgan MRI exam. The analysis pipeline, also adapted from UK Biobank, includes new imaging-derived phenotypes (IDPs) designed to assess the possible effects of COVID-19. A first application of the protocol and pipeline was performed in 51 COVID-19 patients post-hospital discharge and 25 controls participating in the Oxford C-MORE study. The protocol acquires high resolution T1, T2-FLAIR, diffusion weighted images, susceptibility weighted images, and arterial spin labelling data in 17 min. The automated imaging pipeline derives 1,575 IDPs, assessing brain anatomy (including olfactory bulb volume and intensity) and tissue perfusion, hyperintensities, diffusivity, and susceptibility. In the C-MORE data, IDPs related to atrophy, small vessel disease and olfactory bulbs were consistent with clinical radiology reports. Our exploratory analysis tentatively revealed some group differences between recovered COVID-19 patients and controls, across severity groups, but not across anosmia groups. Follow-up imaging in the C-MORE study is currently ongoing, and this protocol is now being used in other large-scale studies. The protocol, pipeline code and data are openly available and will further contribute to the understanding of the medium to long-term effects of COVID-19.
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Affiliation(s)
- Ludovica Griffanti
- Department of Psychiatry, Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Human Brain Activity, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Clinical Neurosciences, Wellcome Centre for Integrative Neuroimaging (WIN FMRIB), University of Oxford, Oxford, United Kingdom
| | - Betty Raman
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Biomedical Research Centre (BRC) National Institute for Health Research (NIHR), University of Oxford, Oxford, United Kingdom
- Radcliffe Department of Medicine, British Heart Foundation Centre for Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Fidel Alfaro-Almagro
- Nuffield Department of Clinical Neurosciences, Wellcome Centre for Integrative Neuroimaging (WIN FMRIB), University of Oxford, Oxford, United Kingdom
| | - Nicola Filippini
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Camillo Hospital, Venice, Italy
| | - Mark Philip Cassar
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Biomedical Research Centre (BRC) National Institute for Health Research (NIHR), University of Oxford, Oxford, United Kingdom
| | - Fintan Sheerin
- Department of Radiology, Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, United Kingdom
| | - Thomas W. Okell
- Nuffield Department of Clinical Neurosciences, Wellcome Centre for Integrative Neuroimaging (WIN FMRIB), University of Oxford, Oxford, United Kingdom
| | - Flora A. Kennedy McConnell
- Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Nottingham Biomedical Research Centre, Queens Medical Centre, University of Nottingham, Nottingham, United Kingdom
| | - Michael A. Chappell
- Nuffield Department of Clinical Neurosciences, Wellcome Centre for Integrative Neuroimaging (WIN FMRIB), University of Oxford, Oxford, United Kingdom
- Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Nottingham Biomedical Research Centre, Queens Medical Centre, University of Nottingham, Nottingham, United Kingdom
| | - Chaoyue Wang
- Nuffield Department of Clinical Neurosciences, Wellcome Centre for Integrative Neuroimaging (WIN FMRIB), University of Oxford, Oxford, United Kingdom
| | - Christoph Arthofer
- Nuffield Department of Clinical Neurosciences, Wellcome Centre for Integrative Neuroimaging (WIN FMRIB), University of Oxford, Oxford, United Kingdom
| | - Frederik J. Lange
- Nuffield Department of Clinical Neurosciences, Wellcome Centre for Integrative Neuroimaging (WIN FMRIB), University of Oxford, Oxford, United Kingdom
| | - Jesper Andersson
- Nuffield Department of Clinical Neurosciences, Wellcome Centre for Integrative Neuroimaging (WIN FMRIB), University of Oxford, Oxford, United Kingdom
| | - Clare E. Mackay
- Department of Psychiatry, Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Human Brain Activity, University of Oxford, Oxford, United Kingdom
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Elizabeth M. Tunnicliffe
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Biomedical Research Centre (BRC) National Institute for Health Research (NIHR), University of Oxford, Oxford, United Kingdom
| | - Matthew Rowland
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, United Kingdom
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Biomedical Research Centre (BRC) National Institute for Health Research (NIHR), University of Oxford, Oxford, United Kingdom
- Radcliffe Department of Medicine, British Heart Foundation Centre for Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Karla L. Miller
- Nuffield Department of Clinical Neurosciences, Wellcome Centre for Integrative Neuroimaging (WIN FMRIB), University of Oxford, Oxford, United Kingdom
| | - Peter Jezzard
- Nuffield Department of Clinical Neurosciences, Wellcome Centre for Integrative Neuroimaging (WIN FMRIB), University of Oxford, Oxford, United Kingdom
| | - Stephen M. Smith
- Nuffield Department of Clinical Neurosciences, Wellcome Centre for Integrative Neuroimaging (WIN FMRIB), University of Oxford, Oxford, United Kingdom
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8
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Boscutti A, Delvecchio G, Pigoni A, Cereda G, Ciappolino V, Bellani M, Fusar-Poli P, Brambilla P. Olfactory and gustatory dysfunctions in SARS-CoV-2 infection: A systematic review. Brain Behav Immun Health 2021; 15:100268. [PMID: 34027497 PMCID: PMC8129998 DOI: 10.1016/j.bbih.2021.100268] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/06/2021] [Accepted: 05/09/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Among Coronavirus Disease 2019 (COVID-19) manifestations, Olfactory (OD) and Gustatory (GD) Dysfunctions (OGD) have drawn considerable attention, becoming a sort of hallmark of the disease. Many have speculated on the pathogenesis and clinical characteristics of these disturbances; however, no definite answers have been produced on the topic. With this systematic review, we aimed to collect all the available evidence regarding the prevalence of OGD, the timing of their onset and their resolution, their rate of recovery and their role as diagnostic and prognostic tools for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. METHODS A systematic review comprising all the observational studies that reported the prevalence and/or the longitudinal trajectories of OGD in COVID-19 patients, as self-reported by patients or measured through objective psychophysical tests. RESULTS After the selection process, 155 studies were included, with a total of 70,920 patients and 105,291 not-infected individuals. Prevalence reports were extremely variable across studies, with wide ranges for OD (0%-98%) and GD (0-89%) prevalence. OGD occurred early during the disease course and only rarely preceded other symptoms; out of 30 studies with a follow-up time of at least 20 days, only in 5 studies OGD fully resolved in more than 90% of patients. OGD had low sensitivity and high specificity for SARS-CoV-2 infection; accuracy of OD and GD for infection identification was higher than 80% in 10 out of 33 studies and in 8 out of 22 studies considered, respectively. 28 out of 30 studies that studied the association between OGD and disease severity found how OGD were associated with lower rates of severe pneumonia, hospitalization and mortality. CONCLUSIONS OGD seem to be highly prevalent in SARS-CoV-2 infection. They occur early, concomitantly with other symptoms and often persist after recovery, in some cases for months; whether a full recovery eventually occurs in all cases is not clear yet. OGD are good predictors of SARS-CoV-2 infection and are associated with a milder disease course.
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Affiliation(s)
- A. Boscutti
- Department of Pathophysiology and Transplantation, University of Milan, 20122, Milan, Italy
| | - G. Delvecchio
- Department of Pathophysiology and Transplantation, University of Milan, 20122, Milan, Italy
| | - A. Pigoni
- Social and Affective Neuroscience Group, MoMiLab, IMT School for Advanced Studies Lucca, Lucca, Italy
| | - G. Cereda
- Department of Pathophysiology and Transplantation, University of Milan, 20122, Milan, Italy
| | - V. Ciappolino
- Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Department of Neurosciences and Mental Health, 20122, Milan, Italy
| | - M. Bellani
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy
- UOC Psychiatry, Azienda Ospedaliera Universitaria Integrata, Verona (AOUI), Italy
| | - P. Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, UK
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - P. Brambilla
- Department of Pathophysiology and Transplantation, University of Milan, 20122, Milan, Italy
- Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Department of Neurosciences and Mental Health, 20122, Milan, Italy
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9
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Veronese S, Sbarbati A. Chemosensory Systems in COVID-19: Evolution of Scientific Research. ACS Chem Neurosci 2021; 12:813-824. [PMID: 33559466 PMCID: PMC7885804 DOI: 10.1021/acschemneuro.0c00788] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/02/2021] [Indexed: 02/07/2023] Open
Abstract
COVID-19 disease induced by coronavirus SARS-CoV-2 presents among its symptoms alterations of the chemosensory functions. In the first studies on the Chinese population, this symptomatology was not particularly relevant, and hyposmia and hypogeusia were excluded from the symptoms to be evaluated to diagnose the disease. With the pandemic spread of the illness, there has been an augment in reports on chemosensory dysfunctions among patients. The first data analysis showed the presence of these disorders mainly in paucisymptomatic and asymptomatic patients. The interest in chemosensory systems therefore increased considerably, because the olfactory and gustatory symptoms could be the key to stop the infection spread. Furthermore, the degree of alert and attention grew, considering that these types of dysfunctions are prognostic symptoms of serious neurodegenerative diseases. About 9 months have passed since the first anecdotal reports on the involvement of the olfactory and gustatory systems in the COVID-19 pathology. For this reason, a careful review of the literature was conducted to understand if it is clearer which people present chemosensory symptoms and if these are related to the severity of the disease. Furthermore, we have identified which aspects still remain to be clarified.
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Affiliation(s)
- Sheila Veronese
- Department of Neuroscience,
Biomedicine and Movement Sciences, University
of Verona, 37134 Verona, Italy
| | - Andrea Sbarbati
- Department of Neuroscience,
Biomedicine and Movement Sciences, University
of Verona, 37134 Verona, Italy
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Transhepatic venous access for hemodialysis-single centre expirience. VOJNOSANIT PREGL 2021. [DOI: 10.2298/vsp200922002s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction. A percutaneous transhepatic approach has been used to place
tunneled catheters in the inferior vena cava for hemodialysis. This route
through the suprahepatic vein could be used to place a tunnelled catheter for
permanent haemodialysis without complications and with an excellent
permeability rate. Single centre expirience. From 2011 to 2020 in a Military
Medical Academy we treated 4 patients with transhepatic central venous
catheter for hemodialysis. All of them had exhausted approaches during period
of hemodialysis. Arterio-venous fistulas had been thrombosed on the arms,
thrombosis subclavian vein billateraly or superior cava veinand complications
by femoral catheters was present. Peritoneal dialysis was not possible.
Discusion. Limited number of papers descripted outcome of placement
transhepatic catheters for hemodialysis. In our expirience one patient needed
scroll catheter due hemodialysis had not well outcome, and one patient needed
thrombolysis catheter.Two of them are on hemodialysis without complications
for 300 and 1650 days. Conclusion. The transhepatic venous access under
ultrasound and radioscopic guidance is a simple and safe method. It is an
acceptable alternative for permanent haemodialysis catheters when other
venous accesses are exhausted, and when it is performed by a well-trained
team.
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