Identifying cerebral microstructural changes in patients with COVID-19 using MRI: A systematic review

Abstract

Coronavirus disease 2019 (COVID-19) is an epidemic viral disease caused by a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite the excessive number of neurological articles that have investigated the effect of COVID-19 on the brain from the neurological point of view, very few studies have investigated the impact of COVID-19 on the cerebral microstructure and function of the brain. The aim of this study was to summarize the results of the existing studies on cerebral microstructural changes in COVID-19 patients, specifically the use of quantitative volumetric analysis, blood oxygen level dependent (BOLD), and diffusion tensor imaging (DTI). We searched PubMed/MEDLINE, ScienceDirect, Semantic Scholar, and Google Scholar from December 2020 to April 2022. A well-constructed search strategy was used to identify the articles for review. Seven research articles have met this study's inclusion and exclusion criteria, which have applied neuroimaging tools such as quantitative volumetric analysis, BOLD, and DTI to investigate cerebral microstructure changes in COVID-19 patients. A significant effect of COVID-19 was found in the brain such as hypoperfusion of cerebral blood flow, increased gray matter (GM) volume, and reduced cortical thickness. The insula and thalamic radiation were the most frequent GM region and white matter tract, respectively, that are involved in SARS-CoV-2. COVID-19 was found to be associated with changes in cerebral microstructures. These abnormalities in brain areas might lead to be associated with behaviors, mental and neurological alterations that need to be considered carefully in future studies.

Keywords: Cerebral; coronavirus disease 2019; magnetic resonance imaging; microstructure; severe acute respiratory syndrome coronavirus 2.

Figure 1

Search strategy used to identify the articles for review following PRISMA guidelines. *Records identified from PubMed/MEDLINE and other databases: ScienceDirect, Semantic Scholar, and Google Scholar. **Records excluded due to they did not directly assess COVID-19-related structural or functional changes using MRI. ***Reason 1: Recruiting only patients’ groups, and case report studies. **** Reason 2: Not available in English. *****Reason 3: Using PET/CT modality. MRI: Magnetic resonance imaging, PET/CT: Positron emission tomography/computed tomography

Figure 2

Consistent results are displayed in the orthogonal projection. Insula GM regions are displayed in red color. The STG region is displayed in copper color. The hippocampus region is displayed in blue color. Thalamic radiation tracts are shown in yellow color. FSL software was used to display the areas of consistence results and overlay them on a standard template MNI152 T1 0.5 mm brain. GM: Gray matter, STG: Superior temporal gyrus