Neuroimaging Findings in Patients with COVID-19: A Systematic Review and Meta-Analysis

Abstract

Objective: Central nervous system involvement in coronavirus disease 2019 (COVID-19) has been increasingly reported. We performed a systematic review and meta-analysis to evaluate the incidence of radiologically demonstrated neurologic complications and detailed neuroimaging findings associated with COVID-19. Materials and Methods: A systematic literature search of MEDLINE/PubMed and EMBASE databases was performed up to September 17, 2020, and studies evaluating neuroimaging findings of COVID-19 using brain CT or MRI were included. Several cohort-based outcomes, including the proportion of patients with abnormal neuroimaging findings related to COVID-19 were evaluated. The proportion of patients showing specific neuroimaging findings was also assessed. Subgroup analyses were also conducted focusing on critically ill COVID-19 patients and results from studies that used MRI as the only imaging modality. Results: A total of 1394 COVID-19 patients who underwent neuroimaging from 17 studies were included; among them, 3.4% of the patients demonstrated COVID-19-related neuroimaging findings. Olfactory bulb abnormalities were the most commonly observed (23.1%). The predominant cerebral neuroimaging finding was white matter abnormality (17.6%), followed by acute/subacute ischemic infarction (16.0%), and encephalopathy (13.0%). Significantly more critically ill patients had COVID-19-related neuroimaging findings than other patients (9.1% vs. 1.6%; p = 0.029). The type of imaging modality used did not significantly affect the proportion of COVID-19-related neuroimaging findings. Conclusion: Abnormal neuroimaging findings were occasionally observed in COVID-19 patients. Olfactory bulb abnormalities were the most commonly observed finding. Critically ill patients showed abnormal neuroimaging findings more frequently than the other patient groups. White matter abnormalities, ischemic infarctions, and encephalopathies were the common cerebral neuroimaging findings.

The Broad Spectrum of Neuro-Radiological Abnormalities in Patients Infected with SARS-CoV-2 Supports the Diagnosis of Neuro-COVID-19

“…I agree with the conclusions that prospective neuroimaging studies are recommended in critically ill COVID-19 patients, considering the high proportion of COVID-19 patients presenting with neuroimaging findings [ 1 ]. The study is an appealing but raises several concerns [ 1 ].…”

“…I read with interest the review article by Kim et al [ 1 ] about the neuroimaging findings in patients with central nervous system (CNS) manifestations of COVID-19 (neuro-COVID). I agree with the conclusions that prospective neuroimaging studies are recommended in critically ill COVID-19 patients, considering the high proportion of COVID-19 patients presenting with neuroimaging findings [ 1 ]. The study is an appealing but raises several concerns [ 1 ].…”

Survivors of SARS-CoV-2 Infection Show Neuropsychiatric Sequelae Measured by Surveys, Neurocognitive Testing, and Magnetic Resonance Imaging: Preliminary Results

“…One potential pathway of neuroinvasion is through the olfactory nerve and bulb. A recent meta-analysis suggests abnormalities in the olfactory bulb are the most common structural neuroimaging findings following COVID-19 infection 19 . Furthermore, structural abnormalities in the olfactory bulb have been associated with anosmia (a partial or complete loss of smell) 20,21 , and there has been speculation in the literature that olfactory dysfunction in COVID-19 may increase risk of future dementia 22 .…”

Looking Ahead to 2022 for the Korean Journal of Radiology

“…The rapid shrinkage of research studies on COVID-19 in radiology was because although radiology is a discipline mainly focused on diagnosis, the approach in dealing with the pandemic has shifted from diagnosis to vaccination and treatment/patient management in 2021. The KJR published eight articles related to COVID-19 in 2021 [ 3 4 5 6 7 8 9 ]. This number was much lower than that in 2020 and only two of them concerned the diagnosis of lung disease (commentaries on articles published in 2020) [ 8 9 ].…”

“…This number was much lower than that in 2020 and only two of them concerned the diagnosis of lung disease (commentaries on articles published in 2020) [ 8 9 ]. Other articles involved vaccination-associated lymphadenopathy [ 3 4 ], a meta-analysis of related neuroimaging findings [ 5 ], and modeling for patient management [ 6 7 ]. These topics reflect the phase shift in dealing with the pandemic.…”