Cerebral Micro-Structural Changes in COVID-19 Patients – An MRI-based 3-month Follow-up Study
Open accessAbstract
Background Increasing evidence supported the possible neuro-invasion potential of SARS-CoV-2. However, no studies were conducted to explore the existence of the micro-structural changes in the central nervous system after infection. We aimed to identify the existence of potential brain micro-structural changes related to SARS-CoV-2. Methods In this prospective study, diffusion tensor imaging (DTI) and 3D high-resolution T1WI sequences were acquired in 60 recovered COVID-19 patients (56.67% male; age: 44.10 ± 16.00) and 39 age- and sex-matched non-COVID-19 controls (56.41% male; age: 45.88 ± 13.90). Registered fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were quantified for DTI, and an index score system was introduced. Regional volumes derived from Voxel-based Morphometry (VBM) and DTI metrics were compared using analysis of covariance (ANCOVA). Two sample t-test and Spearman correlation were conducted to assess the relationships among imaging indices, index scores and clinical information. Findings In this follow-up stage, neurological symptoms were presented in 55% COVID-19 patients. COVID-19 patients had statistically significantly higher bilateral gray matter volumes (GMV) in olfactory cortices, hippocampi, insulas, left Rolandic operculum, left Heschl's gyrus and right cingulate gyrus and a general decline of MD, AD, RD accompanied with an increase of FA in white matter, especially AD in the right CR, EC and SFF, and MD in SFF compared with non-COVID-19 volunteers (corrected p value <0.05). Global GMV, GMVs in left Rolandic operculum, right cingulate, bilateral hippocampi, left Heschl's gyrus, and Global MD of WM were found to correlate with memory loss ( p value <0.05). GMVs in the right cingulate gyrus and left hippocampus were related to smell loss ( p value <0.05). MD-GM score, global GMV, and GMV in right cingulate gyrus were correlated with LDH level ( p value <0.05). Interpretation Study findings revealed possible disruption to micro-structural and functional brain integrity in the recovery stages of COVID-19, suggesting the long-term consequences of SARS-CoV-2. Funding Shanghai Natural Science Foundation, Youth Program of National Natural Science Foundation of China, Shanghai Sailing Program, Shanghai Science and Technology Development, Shanghai Municipal Science and Technology Major Project and ZJ Lab.
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In the recent SARS-CoV-2 or COVID-19 viral outbreak, similar structural damage of frontal cortical areas could be observed, most likely due to an inflammatory response in which parenchymal cells and the choroid plexus are involved.
“In the recent SARS-CoV-2 or COVID-19 viral outbreak, similar structural damage of frontal cortical areas could be observed, most likely due to an inflammatory response in which parenchymal cells and the choroid plexus are involved [345–347].”
From Development of prefrontal cortex (2022) · cites this paper as [345]
The Results (Voxel-based Morphometry) report cortical volume differences in recovered COVID-19 patients, but the frontal-region differences were not statistically significant. The Discussion speculates that a severe inflammatory response might explain reduced global gray-matter volume in some patients; it does not link inflammation to frontal cortical damage or implicate parenchymal cells and the choroid plexus. Page numbers are unavailable in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredMRI changes in COVID-19 patients include hippocampal abnormalities.
“and hippocampal abnormalities [143, 147].”
From Cognitive decline following acute viral infections: literature review and projections for post-COVID-19 (2022) · cites this paper as [143]
MRI studies have shown brain structural and micro-structural changes in COVID-19 patients.
“MRI studies have shown brain structural and micro-structural changes in COVID-19 patients [143–146]”
From Cognitive decline following acute viral infections: literature review and projections for post-COVID-19 (2022) · cites this paper as [143]
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- Authors
- Lu, Y., Li, X., Geng, D., Mei, N., Wu, P.-Y., Huang, C.-C., Jia, T., Zhao, Y., Wang, D., Xiao, A., & Yin, B.
- Affiliations
- Fudan University (CN)
- East China Normal University (CN)
- King's College London (GB)
- Corresponding author
- Xiao, Anling
- Yin, Bo
- ORCID
- Venue
- EClinicalMedicine
- Publisher
- Elsevier BV
- Published
- 2020-08
- Volume
- 25
- Pages
- 100484
- ISSN
- 2589-5370 (ISSN-L)
- PMC
- PMC7396952
- OpenAlex
- W3046814626
- Cited by
- 614
- References
- 40
- Citations by year
- 2026: 25 · 2025: 61 · 2024: 107 · 2023: 112 · 2022: 132 · 2021: 141 · 2020: 36
- FWCI
- 45.57
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- EClinicalMedicine (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Science and Technology Commission of Shanghai Municipality (2018SHZDZX01)
- Natural Science Foundation of Shanghai (18ZR1405700)
- Shanghai Science and Technology Development Foundation (19511121204)
- National Natural Science Foundation of China (81901697)
- Fudan University
- Topics
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced Neuroimaging Techniques and Applications
- Health Sciences › Medicine › Infectious Diseases › Infectious Encephalopathies and Encephalitis
- Keywords
- COVID-19 pandemic, SARS-CoV-2, neuroinvasion, white matter integrity, gray matter volume, diffusion tensor imaging, voxel-based morphometry, post-COVID neurological symptoms, memory loss, anosmia, olfactory cortex, hippocampus, cingulate gyrus, long COVID, follow-up imaging, lactate dehydrogenase, fractional anisotropy, mean diffusivity, axial and radial diffusivity
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