Napolitano Angela, Arrigoni Alberto, Caroli Anna, Cava Mariangela, Remuzzi Andrea, Longhi Luca Giovanni, Barletta Antonino, Zangari Rosalia, Lorini Ferdinando Luca, Sessa Maria, Gerevini Simonetta
Department of Neuroradiology, ASST Papa Giovanni XXIII, Bergamo, Italy.
Bioengineering Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy.
Front Neurol. 2022 May 23;13:884449. doi: 10.3389/fneur.2022.884449. eCollection 2022.
It is increasingly acknowledged that Coronavirus Disease 2019 (COVID-19) can have neurological manifestations, and cerebral microbleeds (CMBs) have been observed in this setting. The aim of this study was to characterize CMBs patterns on susceptibility-weighted imaging (SWI) in hospitalized patients with COVID-19 with neurological manifestations. CMBs volume was quantified and correlated with clinical and laboratory parameters. The study included patients who were hospitalized due to COVID-19, exhibited neurological manifestations, and underwent a brain MRI between March and May 2020. Neurological, clinical, and biochemical variables were reported. The MRI was acquired using a 3T scanner, with a standardized protocol including SWI. Patients were divided based on radiological evidence of CMBs or their absence. The CMBs burden was also assessed with a semi-automatic SWI processing procedure specifically developed for the purpose of this study. Odds ratios (OR) for CMBs were calculated using age, sex, clinical, and laboratory data by logistic regression analysis. Of the 1,760 patients with COVID-19 admitted to the ASST Papa Giovanni XXIII Hospital between 1 March and 31 May 2020, 116 exhibited neurological symptoms requiring neuroimaging evaluation. Of these, 63 patients underwent brain MRI and were therefore included in the study. A total of 14 patients had radiological evidence of CMBs (CMBs+ group). CMBs+ patients had a higher prevalence of CSF inflammation ( = 0.020), a higher white blood cell count ( = 0.020), and lower lymphocytes ( = 0.010); the D-dimer ( = 0.026), LDH ( = 0.004), procalcitonin ( = 0.002), and CRP concentration ( < 0.001) were higher than in the CMBs- group. In multivariable logistic regression analysis, CRP (OR = 1.16, = 0.011) indicated an association with CMBs. Estimated CMBs volume was higher in females than in males and decreased with age (Rho = -0.38; = 0.18); it was positively associated with CRP (Rho = 0.36; = 0.22), and negatively associated with lymphocytes (Rho = -0.52; = 0.07). CMBs are a frequent imaging finding in hospitalized patients with COVID-19 with neurological manifestations and seem to be related to pro-inflammatory status.
越来越多的人认识到，2019冠状病毒病（COVID-19）可出现神经学表现，并且在此情况下已观察到脑微出血（CMB）。本研究的目的是描述有神经学表现的COVID-19住院患者在磁敏感加权成像（SWI）上的CMB模式。对CMB体积进行定量，并与临床和实验室参数相关联。该研究纳入了因COVID-19住院、有神经学表现且在2020年3月至5月期间接受脑部磁共振成像（MRI）检查的患者。报告了神经学、临床和生化变量。使用3T扫描仪获取MRI图像，采用包括SWI的标准化方案。根据有无CMB的影像学证据对患者进行分组。还使用专门为本研究开发的半自动SWI处理程序评估CMB负荷。通过逻辑回归分析，利用年龄、性别、临床和实验室数据计算CMB的比值比（OR）。在2020年3月1日至5月31日期间入住ASST Papa Giovanni XXIII医院的1760例COVID-19患者中，116例出现需要神经影像学评估的神经学症状。其中，63例患者接受了脑部MRI检查，因此被纳入研究。共有14例患者有CMB的影像学证据（CMB+组）。CMB+组患者脑脊液炎症的患病率更高（P = 0.020）、白细胞计数更高（P = 0.020）且淋巴细胞更低（P = 0.010）；D-二聚体（P = 0.026）、乳酸脱氢酶（LDH，P = 0.004）、降钙素原（P = 0.002）和C反应蛋白（CRP）浓度（P < 0.001）均高于CMB-组。在多变量逻辑回归分析中，CRP（OR = 1.16，P = 0.011）表明与CMB有关联。估计的CMB体积女性高于男性，且随年龄增长而减小（Rho = -0.38；P = 0.18）；它与CRP呈正相关（Rho = 0.36；P = 0.22），与淋巴细胞呈负相关（Rho = -0.52；P = 0.07）。CMB是有神经学表现的COVID-19住院患者常见的影像学表现，似乎与促炎状态有关。
