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Observational Study
. 2023 Sep;50(5):470-481.
doi: 10.1016/j.neurad.2023.01.005. Epub 2023 Jan 16.

Cerebral perfusion using ASL in patients with COVID-19 and neurological manifestations: A retrospective multicenter observational study

François-Daniel Ardellier  1 , Seyyid Baloglu  2 , Magdalena Sokolska  3 , Vincent Noblet  4 , François Lersy  2 , Olivier Collange  5 , Jean-Christophe Ferré  6 , Adel Maamar  7 , Béatrice Carsin-Nicol  6 , Julie Helms  8 , Maleka Schenck  9 , Antoine Khalil  10 , Augustin Gaudemer  11 , Sophie Caillard  12 , Julien Pottecher  13 , Nicolas Lefèbvre  14 , Pierre-Emmanuel Zorn  15 , Muriel Matthieu  15 , Jean Christophe Brisset  16 , Clotilde Boulay  17 , Véronique Mutschler  17 , Yves Hansmann  14 , Paul-Michel Mertes  5 , Francis Schneider  9 , Samira Fafi-Kremer  18 , Mickael Ohana  19 , Ferhat Meziani  20 , Nicolas Meyer  21 , Tarek Yousry  22 , Mathieu Anheim  23 , François Cotton  24 , Hans Rolf Jäger  22 , Stéphane Kremer  25 ; SFNR-COVID group
Collaborators, Affiliations
Observational Study

Cerebral perfusion using ASL in patients with COVID-19 and neurological manifestations: A retrospective multicenter observational study

François-Daniel Ardellier et al. J Neuroradiol. 2023 Sep.

Abstract

Background and purpose: Cerebral hypoperfusion has been reported in patients with COVID-19 and neurological manifestations in small cohorts. We aimed to systematically assess changes in cerebral perfusion in a cohort of 59 of these patients, with or without abnormalities on morphological MRI sequences.

Methods: Patients with biologically-confirmed COVID-19 and neurological manifestations undergoing a brain MRI with technically adequate arterial spin labeling (ASL) perfusion were included in this retrospective multicenter study. ASL maps were jointly reviewed by two readers blinded to clinical data. They assessed abnormal perfusion in four regions of interest in each brain hemisphere: frontal lobe, parietal lobe, posterior temporal lobe, and temporal pole extended to the amygdalo-hippocampal complex.

Results: Fifty-nine patients (44 men (75%), mean age 61.2 years) were included. Most patients had a severe COVID-19, 57 (97%) needed oxygen therapy and 43 (73%) were hospitalized in intensive care unit at the time of MRI. Morphological brain MRI was abnormal in 44 (75%) patients. ASL perfusion was abnormal in 53 (90%) patients, and particularly in all patients with normal morphological MRI. Hypoperfusion occurred in 48 (81%) patients, mostly in temporal poles (52 (44%)) and frontal lobes (40 (34%)). Hyperperfusion occurred in 9 (15%) patients and was closely associated with post-contrast FLAIR leptomeningeal enhancement (100% [66.4%-100%] of hyperperfusion with enhancement versus 28.6% [16.6%-43.2%] without, p = 0.002). Studied clinical parameters (especially sedation) and other morphological MRI anomalies had no significant impact on perfusion anomalies.

Conclusion: Brain ASL perfusion showed hypoperfusion in more than 80% of patients with severe COVID-19, with or without visible lesion on conventional MRI abnormalities.

Keywords: COVID-19; Cerebrovascular circulation; Magnetic resonance imaging; Multicenter study; Neuroimaging.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig 1
Fig. 1
Flowchart of patient inclusion.
Fig 2
Fig. 2
Examples of perfusion anomalies qualitatively assessed on cerebral blood flow maps. (A) bilateral frontoparietal hyperperfusion (color scale on the left in mL/100 mg/min). Arrowheads: hypoperfusion in right frontal (B) and temporopolar (C) regions in the same patient.
Fig 3
Fig. 3
Example of leptomeningeal enhancement in a patient with COVID-19. Spin-echo T1-weighted and FLAIR sequences before (A and B) and after (C and D) injection of gadolinium-based contrast agent, showing a diffuse leptomeningeal enhancement after injection. In this study, post-contrast FLAIR was the reference sequence used to assess leptomeningeal enhancement.
Fig 4
Fig. 4
Mean CBF maps of controls (C) and patients (P) in subgroup analysis.
Fig 5
Fig. 5
Comparison of cerebral blood flow (CBF) adjusted for age and sedation from patients with COVID-19 and healthy subjects. Z-score maps thresholded with p-value < 10−3 projected on a template brain image. Blue areas: lower CBF in patients with COVID-19. Red areas: higher CBF in patients with COVID-19.
See this image and copyright information in PMC

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