Insights Imaging . Postmortem brain 7T MRI with minimally invasive pathological correlation in deceased COVID-19 subjects

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Insights Imaging


. 2022 Jan 15;13(1):7.
doi: 10.1186/s13244-021-01144-w.
Postmortem brain 7T MRI with minimally invasive pathological correlation in deceased COVID-19 subjects


Maria da Graça Morais Martin ¹ , Vitor Ribeiro Paes ² , Ellison Fernando Cardoso ³ , Carlos Eduardo Borges Passos Neto ⁴ , Cristina Takami Kanamura ⁵ , Claudia da Costa Leite ⁶ , Maria Concepcion Garcia Otaduy ³ , Renata Aparecida de Almeida Monteiro ² , Thais Mauad ² , Luiz Fernando Ferraz da Silva ⁷ , Luiz Henrique Martins Castro ⁴ , Paulo Hilario Nascimento Saldiva ² , Marisa Dolhnikoff ² , Amaro Nunes Duarte-Neto ^{2 5}



Affiliations

• PMID: 35032223
• DOI: 10.1186/s13244-021-01144-w

Abstract

Background: Brain abnormalities are a concern in COVID-19, so we used minimally invasive autopsy (MIA) to investigate it, consisting of brain 7T MR and CT images and tissue sampling via transethmoidal route with at least three fragments: the first one for reverse transcription polymerase chain reaction (RT-PCR) analysis and the remaining fixed and stained with hematoxylin and eosin. Two mouse monoclonal anti-coronavirus (SARS-CoV-2) antibodies were employed in immunohistochemical (IHC) reactions.
Results: Seven deceased COVID-19 patients underwent MIA with brain MR and CT images, six of them with tissue sampling. Imaging findings included infarcts, punctate brain hemorrhagic foci, subarachnoid hemorrhage and signal abnormalities in the splenium, basal ganglia, white matter, hippocampi and posterior cortico-subcortical. Punctate brain hemorrhage was the most common finding (three out of seven cases). Brain histological analysis revealed reactive gliosis, congestion, cortical neuron eosinophilic degeneration and axonal disruption in all six cases. Other findings included edema (5 cases), discrete perivascular hemorrhages (5), cerebral small vessel disease (3), perivascular hemosiderin deposits (3), Alzheimer type II glia (3), abundant corpora amylacea (3), ischemic foci (1), periventricular encephalitis foci (1), periventricular vascular ectasia (1) and fibrin thrombi (1). SARS-CoV-2 RNA was detected with RT-PCR in 5 out of 5 and IHC in 6 out 6 patients (100%).
Conclusions: Despite limited sampling, MIA was an effective tool to evaluate underlying pathological brain changes in deceased COVID-19 patients. Imaging findings were varied, and pathological features corroborated signs of hypoxia, alterations related to systemic critically ill and SARS-CoV-2 brain invasion.

Keywords: Autopsy; COVID-19; MRI; Neuroimaging; Neuropathology.