Balsak Serdar, Atasoy Bahar, Yabul Fatma, Akcay Ahmet, Yurtsever Ismail, Daskaya Hayrettin, Akkoyunlu Yasemin, Donmez Zeynep, Yaman Kula Aslı, Toluk Ozlem, Alkan Alpay
Department of Radiology, Bezmialem Vakıf University, Istanbul, Turkey.
Department of Radiology, Bakirkoy Sadi Konuk Education and Training Hospital, 34140, Istanbul, Turkey.
Radiologie (Heidelb). 2025 Jan 28. doi: 10.1007/s00117-024-01414-w.
To determine whether there is a difference in apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values in white matter pathways in the subacute period after COVID-19 infection and to evaluate the correlation between diffusion tensor imaging (DTI) metrics and laboratory findings.
The study included 64 healthy controls and 91 patients. Patients were classified as group 1 (all patients, n = 91), group 2 (outpatients, n = 58), or group 3 (inpatients, n = 33). The ADC and FA values were calculated from 10 distinct neuroanatomic localizations; DTI values were compared between groups.
Decreased FA values in the cingulum, corpus callosum splenium and genu (CCS-CCG), forceps major, inferior fronto-occipital fasciculus (IFOF), and middle cerebellar peduncle (MCP) observed in group 1 compared with the control group. Group 1 showed elevated ADC values in CCG. Lower FA and higher ADC values in CCG were shown in group 3. The FA values for CCS, IFOF, and MCP in group 3 were lower than those in the control group. Group 3 had the highest ADC values in the CCS. Additionally, the FA values of the CCG were lower in group 3 than in group 2. Oxygen saturation levels and FA values in the CCG and SFOF exhibited a positive correlation.
We speculate that DTI changes in white matter pathways may be associated with axonal damage and demyelination due to impaired white matter integrity following COVID-19 infection during the subacute period.
Our study showed with DTI findings that there is microstructural damage in white matter pathways in the subacute period of COVID-19 infection and that this damage is related to oxygen saturation levels. Many studies in the literature show that microstructural damage in white matter pathways can lead to clinical neurocognitive dysfunction. We suggest that these cases require more comprehensive studies investigating whether chronic white matter damage is reversible and examining its relationship with neurocognitive dysfunctions in the future.
Neurological involvement is not rare in COVID-19 infection. We examined various white matter pathways with DTI during the subacute period of COVID-19 infection. We showed changes in DTI parameters indicating a decrease in white matter integrity and microstructural damage in the subacute period follow-up of cases with COVID-19. We found that there was a positive correlation between oxygen saturation levels and decreased FA values in white matter tracts.
确定新型冠状病毒肺炎（COVID-19）感染亚急性期白质通路的表观扩散系数（ADC）和分数 anisotropy（FA）值是否存在差异，并评估扩散张量成像（DTI）指标与实验室检查结果之间的相关性。
本研究纳入64名健康对照者和91名患者。患者分为1组（所有患者，n = 91）、2组（门诊患者，n = 58）或3组（住院患者，n = 33）。从10个不同的神经解剖部位计算ADC和FA值；比较各组间的DTI值。
与对照组相比，1组在扣带束、胼胝体压部和膝部（CCS-CCG）、额上枕束、额枕下束（IFOF）和小脑中脚（MCP）观察到FA值降低。1组在CCG中显示ADC值升高。3组在CCG中显示较低的FA值和较高的ADC值。3组中CCS、IFOF和MCP的FA值低于对照组。3组在CCS中ADC值最高。此外，3组中CCG的FA值低于2组。氧饱和度水平与CCG和SFOF中的FA值呈正相关。
我们推测，由于COVID-19感染亚急性期白质完整性受损，白质通路的DTI变化可能与轴突损伤和脱髓鞘有关。
我们的研究通过DTI结果表明，COVID-19感染亚急性期白质通路存在微观结构损伤，且这种损伤与氧饱和度水平有关。文献中的许多研究表明，白质通路的微观结构损伤可导致临床神经认知功能障碍。我们建议，这些病例未来需要更全面的研究，以调查慢性白质损伤是否可逆，并检查其与神经认知功能障碍的关系。
神经受累在COVID-19感染中并不罕见。我们在COVID-19感染亚急性期用DTI检查了各种白质通路。我们显示DTI参数的变化表明COVID-19病例亚急性期随访中白质完整性降低和微观结构损伤。我们发现氧饱和度水平与白质束中降低的FA值之间存在正相关。
