Rane Levendovszky Swati, Patel Payal, Zhu Chengcheng, Rutman Aaron M, Basha Mahmud Mossa
Department of Radiology, University of Washington School of Medicine, Seattle, WA 98195, United States.
Department of Neurology, University of Washington School of Medicine, Seattle, WA 98195, United States.
Br J Radiol. 2025 Aug 1;98(1172):1165-1175. doi: 10.1093/bjr/tqaf090.
COVID-19, caused by SARS-CoV-2, has led to the condition known as Long COVID or post-acute sequelae of COVID-19 (PASC), where individuals experience persistent debilitating symptoms long after the initial infection. We provide here a comprehensive review of findings in the central nervous system associated with PASC. Neuroimaging has been instrumental in identifying brain changes associated with PASC. Structural MRI studies consistently reveal grey matter volume reductions in the frontal and temporal lobes and white matter hyperintensities, particularly in the periventricular regions. Studies especially found these changes to correlate strongly with cognitive deficits. Diffusion tensor imaging has shown increased tissue damage and oedema in the brain's white matter tracts, particularly in the sagittal stratum and thalamic radiation. Resting-state functional MRI studies indicate altered brain connectivity in PASC patients, especially in those with post-traumatic stress symptoms. Reduced connectivity within and between critical networks, such as the default mode network and the executive control network, has been observed. These changes correlate with cognitive impairments, such as attention and memory deficits. Dynamic functional connectivity analyses further reveal that PASC patients spend less time in states with rich inter-regional connectivity, and transitions between connectivity states were linked to post-traumatic stress disorder symptoms. Positron emission tomography scans have shown hypometabolism in the frontal and temporal lobes, particularly in regions associated with memory and executive functions. Hypometabolism in the hippocampus and thalamus is linked to symptoms like anosmia and fatigue. Despite the heterogeneity in clinical presentations and diagnostic criteria, these neuroimaging findings underscore the significant impact of COVID-19 on brain structure and function. Continued research using advanced imaging techniques is essential for a deeper understanding of PASC's neurological effects. This will aid in developing targeted interventions and improving outcomes for those affected by Long COVID and inform studies investigating downstream effects of viral infections on the brain.
由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起的2019冠状病毒病（COVID-19）导致了所谓的“长新冠”或COVID-19急性后遗症（PASC），即个体在初次感染后很长时间仍经历持续的衰弱症状。我们在此对与PASC相关的中枢神经系统研究结果进行全面综述。神经影像学在识别与PASC相关的脑部变化方面发挥了重要作用。结构磁共振成像（MRI）研究一致显示额叶和颞叶灰质体积减少以及白质高信号，特别是在脑室周围区域。研究特别发现这些变化与认知缺陷密切相关。扩散张量成像显示大脑白质束中的组织损伤和水肿增加，尤其是在矢状层和丘脑辐射区。静息态功能MRI研究表明PASC患者的大脑连接性改变，特别是那些有创伤后应激症状的患者。已观察到关键网络内部和之间的连接性降低，如默认模式网络和执行控制网络。这些变化与认知障碍相关，如注意力和记忆缺陷。动态功能连接分析进一步表明，PASC患者处于区域间连接丰富状态的时间较少，连接状态之间的转换与创伤后应激障碍症状有关。正电子发射断层扫描显示额叶和颞叶代谢减退，特别是在与记忆和执行功能相关的区域。海马体和丘脑的代谢减退与嗅觉丧失和疲劳等症状有关。尽管临床表现和诊断标准存在异质性，但这些神经影像学发现强调了COVID-19对脑结构和功能的重大影响。使用先进成像技术的持续研究对于更深入了解PASC的神经学影响至关重要。这将有助于开发针对性干预措施并改善长新冠患者的预后，并为研究病毒感染对大脑的下游影响提供信息。
