Quantitative susceptibility mapping at 7 T in COVID-19: brainstem effects and outcome associations

作者：Catarina Rua, Betty Raman, Christopher T. Rodgers, Virginia Newcombe, Anne E. Manktelow, Doris A. Chatfield, Stephen Sawcer, Joanne Outtrim, Victoria Lupson, Emmanuel A. Stamatakis, Guy Williams, William T. Clarke, Lin Qiu, Martyn Ezra, Rory McDonald, Stuart Clare, Mark Philip Cassar, Stefan Neubauer, Karen D. Ersche, Edward T. Bullmore, David Menon, Kyle T.S. Pattinson, James B. Rowe · 发表于：Brain · 年份：2024 · DOI：10.1093/brain/awae215 · 被引用次数：37 · 研究领域：Long-Term Effects of COVID-19、Functional Brain Connectivity Studies、Infectious Encephalopathies and Encephalitis

Post-mortem studies have shown that patients dying from severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection frequently have pathological changes in their CNS, particularly in the brainstem. Many of these changes are proposed to result from para-infectious and/or post-infection immune responses. Clinical symptoms such as fatigue, breathlessness, and chest pain are frequently reported in post-hospitalized coronavirus disease 2019 (COVID-19) patients. We propose that these symptoms are in part due to damage to key neuromodulatory brainstem nuclei. While brainstem involvement has been demonstrated in the acute phase of the illness, the evidence of long-term brainstem change on MRI is inconclusive. We therefore used ultra-high field (7 T) quantitative susceptibility mapping (QSM) to test the hypothesis that brainstem abnormalities persist in post-COVID patients and that these are associated with persistence of key symptoms. We used 7 T QSM data from 30 patients, scanned 93-548 days after hospital admission for COVID-19 and compared them to 51 age-matched controls without prior history of COVID-19 infection. We correlated the patients' QSM signals with disease severity (duration of hospital admission and COVID-19 severity scale), inflammatory response during the acute illness (C-reactive protein, D-dimer and platelet levels), functional recovery (modified Rankin scale), depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder-7). In COV...