Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt.
Division of Radiology, Department of Internal Medicine, Medical College, Najran University, Najran, Kingdom of Saudi Arabia.
Acad Radiol. 2024 Jun;31(6):2536-2549. doi: 10.1016/j.acra.2024.03.018. Epub 2024 Apr 12.
Neurological complications associated with coronavirus disease (COVID-19) have been reported in children; however, data on neuroimaging findings remain limited. This study aimed to comprehensively examine neuroimaging patterns of COVID-19 in children and their relationship with clinical outcomes.
This retrospective cross-sectional study involved reviewing the medical records and MRI scans of 95 children who developed new neurological symptoms within 2-4 weeks of clinical and laboratory confirmation of COVID-19. Patients were categorized into four groups based on guidelines approved by the Centers for Disease Control and Prevention (CDC). Initial brain/spinal MRI was performed. Images were reviewed by three blinded radiologists, and the findings were analyzed and categorized based on the observed patterns in the brain and spinal cord. Follow-up MRI was performed and analyzed to track lesion progression.
Encephalopathy was the most common neurological symptom (50.5%). The most common initial MRI involvement patterns were non-confluent multifocal hyperintense white matter (WM) lesions (36.8%) and ischemia (18.9%). Most patients who underwent follow-up MRI (n = 56) showed complete resolution (69.9%); however, some patients developed encephalomalacia and myelomalacia (23.2% and 7.1%, respectively). Non-confluent hyperintense WM lesions were associated with good outcomes (45.9%, P = 0.014), whereas ischemia and hemorrhage were associated with poor outcomes (44.1%, P < 0.001).
This study revealed diverse neuroimaging patterns in pediatric COVID-19 patients. Non-confluent WM lesions were associated with good outcomes, whereas ischemia and hemorrhage were associated with poorer prognoses. Understanding these patterns is crucial for their early detection, accurate diagnosis, and appropriate management.
已有研究报道，儿童感染冠状病毒病（COVID-19）后可能出现神经系统并发症，但有关神经影像学表现的数据仍然有限。本研究旨在全面检查 COVID-19 患儿的神经影像学模式及其与临床结局的关系。
这是一项回顾性的病例对照研究，共纳入了 95 名在临床和实验室确诊 COVID-19 后 2-4 周内出现新发神经系统症状的儿童患者。患者根据美国疾病控制与预防中心（CDC）批准的指南分为四组。所有患者均进行了初始脑部/脊髓 MRI 检查，由 3 位盲法阅片的放射科医生进行阅片，根据脑和脊髓的观察到的表现对结果进行分析和分类。对所有患者进行了随访 MRI 检查以跟踪病灶进展。
脑病是最常见的神经系统症状（50.5%）。最常见的初始 MRI 表现为非融合性多灶性高信号脑白质（WM）病变（36.8%）和缺血（18.9%）。大多数接受了随访 MRI 检查的患者（n=56）显示完全缓解（69.9%）；然而，部分患者出现了脑软化和脊髓软化（分别为 23.2%和 7.1%）。非融合性高信号 WM 病变与良好结局相关（45.9%，P=0.014），而缺血和出血与不良结局相关（44.1%，P<0.001）。
本研究揭示了 COVID-19 患儿的多种神经影像学表现。非融合性 WM 病变与良好结局相关，而缺血和出血与预后较差相关。了解这些表现对于早期发现、准确诊断和适当管理至关重要。
