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Brain MRI findings in neurologically symptomatic COVID-19 patients: a systematic review and meta-analysis

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Abstract

Background

Coronavirus disease 2019 (COVID-19) has been associated with nervous system involvement, with more than one-third of COVID-19 patients experiencing neurological manifestations. Utilizing a systematic review, this study aims to summarize brain MRI findings in COVID-19 patients presenting with neurological symptoms.

Methods

Systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) checklist. The electronic databases of PubMed/MEDLINE, Embase, Scopus, and Web of Science were systematically searched for literature addressing brain MRI findings in COVID-19 patients with neurological symptoms.

Results

25 publications containing a total number of 3118 COVID-19 patients with neurological symptoms who underwent MRI were included. The most common MRI findings and the respective pooled incidences in decreasing order were acute/subacute infarct (22%), olfactory bulb abnormalities (22%), white matter abnormalities (20%), cerebral microbleeds (17%), grey matter abnormalities (12%), leptomeningeal enhancement (10%), ADEM (Acute Disseminated Encephalomyelitis) or ADEM-like lesions (10%), non-traumatic ICH (10%), cranial neuropathy (8%), cortical gray matter signal changes compatible with encephalitis (8%), basal ganglia abnormalities (5%), PRES (Posterior Reversible Encephalopathy Syndrome) (3%), hypoxic-ischemic lesions (4%), venous thrombosis (2%), and cytotoxic lesions of the corpus callosum (2%).

Conclusion

The present study revealed that a considerable proportion of patients with COVID-19 might harbor neurological abnormalities detectable by MRI. Among various findings, the most common MRI alterations are acute/subacute infarction, olfactory bulb abnormalities, white matter abnormalities, and cerebral microbleeds.

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Abbreviations

SARS-COV-2:

Severe acute respiratory syndrome coronavirus 2

MRI:

Magnetic resonance imaging

RT-PCR:

Reverse transcriptase-polymerase chain reaction

FLAIR:

Fluid-attenuated inversion recovery

ICU:

Intensive care units

ARDS:

Acute respiratory distress syndrome

RNA:

Ribonucleic acid

CT scan:

Computerized tomography scan

EEG:

Electroencephalogram

CI:

Confidence interval

COVID-19:

Coronavirus disease 2019

ADEM:

Acute disseminated encephalomyelitis

PRES:

Posterior reversible encephalopathy syndrome

IPH:

Intraparenchymal hemorrhage

SDH:

Subdural hematoma

SAH:

Subarachnoid hemorrhage

ICH:

Intracranial hemorrhage

fMRI:

Functional magnetic resonance imaging

FDG-PET:

Fluorodeoxyglucose-positron emission tomography

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Funding

The authors state that this research has not received any specific grant from funding agencies in the public, commercial, or non-for-profit sectors. The following authors of this manuscript declare relationships with the mentioned companies: Dr. Alexander M. Norbash is scientific adviser to Stryker and Penumbra, co-founder and stockholder of Boston Imaging Core Laboratories, and research grant recipient from Canon, Inc. Dr. Ghazaleh Afsahi is affiliated with Department of Biotechnology Research, Blue California Ingredients company, Rancho Santa Margarita, California, USA.

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Authors and Affiliations

  1. Department of Radiology, University of California, San Diego, CA, USA

    Amir Masoud Afsahi, Alexander M. Norbash, Hyungseok Jang & Sam Sedaghat

  2. Department of Radiology, Weill Cornell Medicine, New York, NY, USA

    Shahla F. Syed

  3. Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany

    Sam Sedaghat

  4. Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany

    Maya Sedaghat

  5. Department of Biotechnology Research, Blue California Ingredients, Rancho Santa Margarita, CA, USA

    Ghazaleh Afsahi

  6. School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran

    Ramin Shahidi

  7. Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran

    Zohreh Tajabadi & Fattaneh Khalaj

  8. Qom University of Medical Sciences, Qom, Iran

    Mahsa Bagherzadeh-Fard & Mohammad Amin Habibi

  9. School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

    Shaghayegh Karami & Pourya Yarahmadi

  10. Department of Psychology, Faculty of Education and Psychology, University of Tabriz, Tabriz, Iran

    Shabnam Shirdel

  11. Students Research Committee, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran

    Ali Asgarzadeh

  12. Department of Radiology, Imam Ali Hospital, North Khorasan University of Medical Science, Bojnurd, Iran

    Mansoureh Baradaran

  13. Department of Artificial Intelligence in Medical Sciences, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran

    Hamidreza Sadeghsalehi

  14. Quantitative MR Imaging and Spectroscopy Group (QMISG), Research Centre for Molecular and Cellular Imaging (RCMCI), Advanced Medical Technologies and Equipment Institute (AMTEI), Tehran University of Medical Sciences (TUMS), Tehran, Iran

    Maryam Fotouhi

  15. Department of Diagnostic Radiology and Nuclear Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Abass Alavi

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  1. Amir Masoud Afsahi
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Correspondence to Amir Masoud Afsahi.

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Afsahi, A.M., Norbash, A.M., Syed, S.F. et al. Brain MRI findings in neurologically symptomatic COVID-19 patients: a systematic review and meta-analysis. J Neurol 270, 5131–5154 (2023). https://doi.org/10.1007/s00415-023-11914-9

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