tetano
Editor, Senior Moderator
J Neuroradiol
. 2021 Nov 18;S0150-9861(21)00167-X.
doi: 10.1016/j.neurad.2021.11.003. Online ahead of print.
The extent of neuroradiological findings in COVID-19 shows correlation with blood biomarkers, Glasgow Coma Scale score and days in intensive care
Fällmar David[SUP] 1 [/SUP], Rostami Elham[SUP] 2 [/SUP], Kumlien Eva[SUP] 3 [/SUP], Ashton Nicholas J[SUP] 4 [/SUP], Jackmann Sven[SUP] 3 [/SUP], Pavel Radu[SUP] 5 [/SUP], Blennow Kaj[SUP] 6 [/SUP], Hultström Michael[SUP] 7 [/SUP], Lipcsey Miklos[SUP] 8 [/SUP], Frithiof Robert[SUP] 9 [/SUP], Westman Gabriel[SUP] 10 [/SUP], Zetterberg Henrik[SUP] 11 [/SUP], Wikström Johan[SUP] 5 [/SUP], Virhammar Johan[SUP] 3 [/SUP]
Affiliations
Abstract
Background and purpose: A wide range of neuroradiological findings has been reported in patients with coronavirus disease 2019 (COVID-19), ranging from subcortical white matter changes to infarcts, haemorrhages and focal contrast media enhancement. These have been descriptively but inconsistently reported and correlations with clinical findings and biomarkers have been difficult to extract from the literature. The purpose of this study was to quantify the extents of neuroradiological findings in a cohort of patients with COVID-19 and neurological symptoms, and to investigate correlations with clinical findings, duration of intensive care and biomarkers in blood.
Material and methods: Patients with positive SARS-CoV-2 and at least one new-onset neurological symptom were included from April until July 2020. Nineteen patients were examined regarding clinical symptoms, biomarkers in blood and MRI of the brain. In order to quantify the MRI findings, a semi-quantitative neuroradiological severity scale was constructed a priori, and applied to the MR images by two specialists in neuroradiology.
Results and conclusions: The score from the severity scale correlated significantly with blood biomarkers of CNS injury (glial fibrillary acidic protein, total-tau, ubiquitin carboxyl-terminal hydrolase L1) and inflammation (C-reactive protein), Glasgow Coma Scale score, and the number of days spent in intensive care. The underlying radiological assessments had inter-rater agreements of 90.5%/86% (for assessments with 2/3 alternatives). Total intraclass correlation was 0.80. Previously reported neuroradiological findings in COVID-19 have been diverse and heterogenous. In this study, the extent of findings in MRI examination of the brain, quantified using a structured report, shows correlation with relevant biomarkers.
Keywords: COVID-19, coronavirus disease 2019; COVID-19, neuroradiology, biomarkers, MRI, brain Abbreviations ADEM, acute disseminating encephalomyelitis; CRP, C-reactive protein; GCS, Glasgow Coma Scale; GFAp, glial fibrillary acidic protein; ICU, intensive care unit; IL-6, interleukin-6; NIH, national institute of health; Nerases, neuroradiological severity scale; NfL, neurofilament light chain; PCR, polymerase chain reaction; SARS-CoV-2, severe acute respiratory syndrome coronavirus-2; SWI, susceptibility weighted imaging; UCHL1, ubiquitin carboxy-terminal hydrolase L1; t-tau, total tau.
. 2021 Nov 18;S0150-9861(21)00167-X.
doi: 10.1016/j.neurad.2021.11.003. Online ahead of print.
The extent of neuroradiological findings in COVID-19 shows correlation with blood biomarkers, Glasgow Coma Scale score and days in intensive care
Fällmar David[SUP] 1 [/SUP], Rostami Elham[SUP] 2 [/SUP], Kumlien Eva[SUP] 3 [/SUP], Ashton Nicholas J[SUP] 4 [/SUP], Jackmann Sven[SUP] 3 [/SUP], Pavel Radu[SUP] 5 [/SUP], Blennow Kaj[SUP] 6 [/SUP], Hultström Michael[SUP] 7 [/SUP], Lipcsey Miklos[SUP] 8 [/SUP], Frithiof Robert[SUP] 9 [/SUP], Westman Gabriel[SUP] 10 [/SUP], Zetterberg Henrik[SUP] 11 [/SUP], Wikström Johan[SUP] 5 [/SUP], Virhammar Johan[SUP] 3 [/SUP]
Affiliations
- PMID: 34800562
- DOI: 10.1016/j.neurad.2021.11.003
Abstract
Background and purpose: A wide range of neuroradiological findings has been reported in patients with coronavirus disease 2019 (COVID-19), ranging from subcortical white matter changes to infarcts, haemorrhages and focal contrast media enhancement. These have been descriptively but inconsistently reported and correlations with clinical findings and biomarkers have been difficult to extract from the literature. The purpose of this study was to quantify the extents of neuroradiological findings in a cohort of patients with COVID-19 and neurological symptoms, and to investigate correlations with clinical findings, duration of intensive care and biomarkers in blood.
Material and methods: Patients with positive SARS-CoV-2 and at least one new-onset neurological symptom were included from April until July 2020. Nineteen patients were examined regarding clinical symptoms, biomarkers in blood and MRI of the brain. In order to quantify the MRI findings, a semi-quantitative neuroradiological severity scale was constructed a priori, and applied to the MR images by two specialists in neuroradiology.
Results and conclusions: The score from the severity scale correlated significantly with blood biomarkers of CNS injury (glial fibrillary acidic protein, total-tau, ubiquitin carboxyl-terminal hydrolase L1) and inflammation (C-reactive protein), Glasgow Coma Scale score, and the number of days spent in intensive care. The underlying radiological assessments had inter-rater agreements of 90.5%/86% (for assessments with 2/3 alternatives). Total intraclass correlation was 0.80. Previously reported neuroradiological findings in COVID-19 have been diverse and heterogenous. In this study, the extent of findings in MRI examination of the brain, quantified using a structured report, shows correlation with relevant biomarkers.
Keywords: COVID-19, coronavirus disease 2019; COVID-19, neuroradiology, biomarkers, MRI, brain Abbreviations ADEM, acute disseminating encephalomyelitis; CRP, C-reactive protein; GCS, Glasgow Coma Scale; GFAp, glial fibrillary acidic protein; ICU, intensive care unit; IL-6, interleukin-6; NIH, national institute of health; Nerases, neuroradiological severity scale; NfL, neurofilament light chain; PCR, polymerase chain reaction; SARS-CoV-2, severe acute respiratory syndrome coronavirus-2; SWI, susceptibility weighted imaging; UCHL1, ubiquitin carboxy-terminal hydrolase L1; t-tau, total tau.