tetano
Editor, Senior Moderator
AJNR Am J Neuroradiol
. 2021 Mar 11.
doi: 10.3174/ajnr.A7072. Online ahead of print.
Brain and Lung Imaging Correlation in Patients with COVID-19: Could the Severity of Lung Disease Reflect the Prevalence of Acute Abnormalities on Neuroimaging? A Global Multicenter Observational Study
A Mahammedi[SUP] 1 [/SUP], A Ramos[SUP] 2 [/SUP], N Bargall?[SUP] 3 [/SUP], M Gaskill[SUP] 4 [/SUP], S Kapur[SUP] 4 [/SUP], L Saba[SUP] 5 [/SUP], H Carrete Jr[SUP] 6 [/SUP], S Sengupta[SUP] 4 [/SUP], E Salvador[SUP] 7 [/SUP], A Hilario[SUP] 7 [/SUP], Y Revilla[SUP] 7 [/SUP], M Sanchez[SUP] 3 [/SUP], M Perez-Nu?ez[SUP] 7 [/SUP], S Bachir[SUP] 6 [/SUP], B Zhang[SUP] 2 [/SUP], L Oleaga[SUP] 3 [/SUP], J Sergio[SUP] 3 [/SUP], L Koren[SUP] 7 [/SUP], P Martin-Medina[SUP] 7 [/SUP], L Wang[SUP] 4 [/SUP], M Benegas[SUP] 3 [/SUP], F Ostos[SUP] 7 [/SUP], G Gonzalez-Ortega[SUP] 7 [/SUP], P Calleja[SUP] 7 [/SUP], G Udstuen[SUP] 4 [/SUP], B Williamson[SUP] 4 [/SUP], V Khandwala[SUP] 4 [/SUP], S Chadalavada[SUP] 4 [/SUP], D Woo[SUP] 4 [/SUP], A Vagal[SUP] 4 [/SUP]
Affiliations
Abstract
Purpose: Our aim was to study the association between abnormal findings on chest and brain imaging in patients with coronavirus disease 2019 (COVID-19) and neurologic symptoms.
Materials and methods: In this retrospective, international multicenter study, we reviewed the electronic medical records and imaging of hospitalized patients with COVID-19 from March 3, 2020, to June 25, 2020. Our inclusion criteria were patients diagnosed with Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infection with acute neurologic manifestations and available chest CT and brain imaging. The 5 lobes of the lungs were individually scored on a scale of 0-5 (0 corresponded to no involvement and 5 corresponded to >75% involvement). A CT lung severity score was determined as the sum of lung involvement, ranging from 0 (no involvement) to 25 (maximum involvement).
Results: A total of 135 patients met the inclusion criteria with 132 brain CT, 36 brain MR imaging, 7 MRA of the head and neck, and 135 chest CT studies. Compared with 86 (64%) patients without acute abnormal findings on neuroimaging, 49 (36%) patients with these findings had a significantly higher mean CT lung severity score (9.9 versus 5.8, P < .001). These patients were more likely to present with ischemic stroke (40 [82%] versus 11 [13%], P < .0001) and were more likely to have either ground-glass opacities or consolidation (46 [94%] versus 73 [84%], P = .01) in the lungs. A threshold of the CT lung severity score of >8 was found to be 74% sensitive and 65% specific for acute abnormal findings on neuroimaging. The neuroimaging hallmarks of these patients were acute ischemic infarct (28%), intracranial hemorrhage (10%) including microhemorrhages (19%), and leukoencephalopathy with and/or without restricted diffusion (11%). The predominant CT chest findings were peripheral ground-glass opacities with or without consolidation.
Conclusions: The CT lung disease severity score may be predictive of acute abnormalities on neuroimaging in patients with COVID-19 with neurologic manifestations. This can be used as a predictive tool in patient management to improve clinical outcome.
. 2021 Mar 11.
doi: 10.3174/ajnr.A7072. Online ahead of print.
Brain and Lung Imaging Correlation in Patients with COVID-19: Could the Severity of Lung Disease Reflect the Prevalence of Acute Abnormalities on Neuroimaging? A Global Multicenter Observational Study
A Mahammedi[SUP] 1 [/SUP], A Ramos[SUP] 2 [/SUP], N Bargall?[SUP] 3 [/SUP], M Gaskill[SUP] 4 [/SUP], S Kapur[SUP] 4 [/SUP], L Saba[SUP] 5 [/SUP], H Carrete Jr[SUP] 6 [/SUP], S Sengupta[SUP] 4 [/SUP], E Salvador[SUP] 7 [/SUP], A Hilario[SUP] 7 [/SUP], Y Revilla[SUP] 7 [/SUP], M Sanchez[SUP] 3 [/SUP], M Perez-Nu?ez[SUP] 7 [/SUP], S Bachir[SUP] 6 [/SUP], B Zhang[SUP] 2 [/SUP], L Oleaga[SUP] 3 [/SUP], J Sergio[SUP] 3 [/SUP], L Koren[SUP] 7 [/SUP], P Martin-Medina[SUP] 7 [/SUP], L Wang[SUP] 4 [/SUP], M Benegas[SUP] 3 [/SUP], F Ostos[SUP] 7 [/SUP], G Gonzalez-Ortega[SUP] 7 [/SUP], P Calleja[SUP] 7 [/SUP], G Udstuen[SUP] 4 [/SUP], B Williamson[SUP] 4 [/SUP], V Khandwala[SUP] 4 [/SUP], S Chadalavada[SUP] 4 [/SUP], D Woo[SUP] 4 [/SUP], A Vagal[SUP] 4 [/SUP]
Affiliations
- PMID: 33707278
- DOI: 10.3174/ajnr.A7072
Abstract
Purpose: Our aim was to study the association between abnormal findings on chest and brain imaging in patients with coronavirus disease 2019 (COVID-19) and neurologic symptoms.
Materials and methods: In this retrospective, international multicenter study, we reviewed the electronic medical records and imaging of hospitalized patients with COVID-19 from March 3, 2020, to June 25, 2020. Our inclusion criteria were patients diagnosed with Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infection with acute neurologic manifestations and available chest CT and brain imaging. The 5 lobes of the lungs were individually scored on a scale of 0-5 (0 corresponded to no involvement and 5 corresponded to >75% involvement). A CT lung severity score was determined as the sum of lung involvement, ranging from 0 (no involvement) to 25 (maximum involvement).
Results: A total of 135 patients met the inclusion criteria with 132 brain CT, 36 brain MR imaging, 7 MRA of the head and neck, and 135 chest CT studies. Compared with 86 (64%) patients without acute abnormal findings on neuroimaging, 49 (36%) patients with these findings had a significantly higher mean CT lung severity score (9.9 versus 5.8, P < .001). These patients were more likely to present with ischemic stroke (40 [82%] versus 11 [13%], P < .0001) and were more likely to have either ground-glass opacities or consolidation (46 [94%] versus 73 [84%], P = .01) in the lungs. A threshold of the CT lung severity score of >8 was found to be 74% sensitive and 65% specific for acute abnormal findings on neuroimaging. The neuroimaging hallmarks of these patients were acute ischemic infarct (28%), intracranial hemorrhage (10%) including microhemorrhages (19%), and leukoencephalopathy with and/or without restricted diffusion (11%). The predominant CT chest findings were peripheral ground-glass opacities with or without consolidation.
Conclusions: The CT lung disease severity score may be predictive of acute abnormalities on neuroimaging in patients with COVID-19 with neurologic manifestations. This can be used as a predictive tool in patient management to improve clinical outcome.