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The extent of neuroradiological findings in COVID-19 shows correlation with blood biomarkers, Glasgow coma scale score and days in intensive care - 03/11/22

Doi : 10.1016/j.neurad.2021.11.003 
David Fällmar a, , Elham Rostami b, Eva Kumlien c, Nicholas J. Ashton d, e, f, g, Sven Jackmann c, Radu Pavel a, Kaj Blennow d, h, Michael Hultström i, j, Miklos Lipcsey i, k, Robert Frithiof i, Gabriel Westman l, Henrik Zetterberg d, h, m, n, Johan Wikström a, Johan Virhammar c
a Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden 
b Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden 
c Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden 
d Department of Psychiatry and Neurochemistry, Institute of Neuroscience & Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden 
e Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden 
f Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Institute Clinical Neuroscience Institute, King's College London, London, UK 
g NIHR Biomedical Research Centre for Mental Health and Biomedical Research Unit for Dementia at South London and Maudsley NHS Foundation, London, UK 
h Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden 
i Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden 
j Department of Medical Cell Biology, Integrative Physiology, Uppsala University, Uppsala, Sweden 
k Hedenstierna Laboratory, CIRRUS, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden 
l Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden 
m Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK 
n UK Dementia Research Institute at UCL, London, UK 

Corresponding author.

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Highlight

Patients with COVID-19 and neurological symptoms were extensively studied.
The extent of brain MRI findings was quantified with a structured report.
The report was created a priori, based on papers describing 197 patients with MRI.
The score correlated with biomarkers, GCS, and number of days in intensive care.
Correlation was strong with GFAp and t-tau in plasma - biomarkers for CNS damage.

El texto completo de este artículo está disponible en PDF.

Abstract

Background and purpose

A wide range of neuroradiological findings has been reported in patients with coronavirus disease 2019 (COVID-19), ranging from subcortical white matter changes to infarcts, haemorrhages and focal contrast media enhancement. These have been descriptively but inconsistently reported and correlations with clinical findings and biomarkers have been difficult to extract from the literature. The purpose of this study was to quantify the extents of neuroradiological findings in a cohort of patients with COVID-19 and neurological symptoms, and to investigate correlations with clinical findings, duration of intensive care and biomarkers in blood.

Material and methods

Patients with positive SARS-CoV-2 and at least one new-onset neurological symptom were included from April until July 2020. Nineteen patients were examined regarding clinical symptoms, biomarkers in blood and MRI of the brain. In order to quantify the MRI findings, a semi-quantitative neuroradiological severity scale was constructed a priori, and applied to the MR images by two specialists in neuroradiology.

Results and conclusions

The score from the severity scale correlated significantly with blood biomarkers of CNS injury (glial fibrillary acidic protein, total-tau, ubiquitin carboxyl-terminal hydrolase L1) and inflammation (C-reactive protein), Glasgow Coma Scale score, and the number of days spent in intensive care. The underlying radiological assessments had inter-rater agreements of 90.5%/86% (for assessments with 2/3 alternatives). Total intraclass correlation was 0.80.

Previously reported neuroradiological findings in COVID-19 have been diverse and heterogenous. In this study, the extent of findings in MRI examination of the brain, quantified using a structured report, shows correlation with relevant biomarkers.

El texto completo de este artículo está disponible en PDF.

Keywords : COVID-19, Neuroradiology, Biomarkers, MRI, Brain, Severity scale

Abbreviations : ADEM, COVID-19, CRP, GCS, GFAp, ICU, IL-6, Nerases, NfL, NIH, PCR, SARS-CoV-2, SWI, t-tau, UCHL1


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© 2021  The Author(s). Publicado por Elsevier Masson SAS. Todos los derechos reservados.
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Vol 49 - N° 6

P. 421-427 - novembre 2022 Regresar al número
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