Radiology. 2020 Jul 30:202791. doi: 10.1148/radiol.2020202791. Online ahead of print.
Background Neurological complications in coronavirus disease 2019 (COVID-19) have been described, but the understanding of their pathophysiology 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 PCR-positivity for SARS-CoV-2, undergoing 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 185 patients with COVID-19 (62±14 years, 138 men) underwent neuroimaging. In total, 222 brain CT, 47 brain MRI and 7 spinal MRI scans were performed. Intra-axial susceptibility abnormalities were the most common finding (29 of 39 [74%, 95%-CI 58-87%]) in patients with brain MRI, often with an ovoid shape suggestive of microvascular pathology, and with a predilection to 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 seen, but vascular imaging did not reveal 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 (7 of 37, 19%), prominent optic nerve subarachnoid spaces (20 of 36, 56%), and enhancement of the parenchyma (3 of 20, 15%), leptomeninges (3 of 20, 15%), cranial nerves (2 of 20, 10%), and spinal nerves (2 of 4, 50%). At MRI follow-up, regression of leukoencephalopathy and progressive leptomeningeal enhancement was observed in one patient respectively, suggestive of dynamic processes. Conclusion Patients with COVID-19 had a wide spectrum of vascular and inflammatory involvement of both the central and peripheral nervous system.