Brain MRI of Covid 19 patients related to presence of virus in CSF: Study

The presence of CNS hyperintense lesions or leptomeningeal enhancement on neuroimaging from patients with COVID-19 is associated with increased likelihood of a positive CSF SARS-CoV-2 PCR, suggests findings from a recent study published in Journal of Neuroimaging . However, the research team further elaborated that s a positive CSF SARS-CoV-2 PCR is uncommon in patients with these neuroimaging findings, suggesting they are often related to other etiologies, such as inflammation, hypoxia, or ischemia.

Patients with coronavirus disease 2019 (COVID-19) who have neurological symptoms often have central nervous system (CNS) hyperintense lesions and/or leptomeningeal enhancement on neuroimaging.Postulated mechanisms for these findings include ischemia, inflammation, anoxia, and viral neuroinvasion. Cerebrospinal fluid (CSF) testing is one means to evaluate for viral neuroinvasion via (1) the severe acute respiratory syndrome associated coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) assay or (2) testing for intrathecal SARS-CoV-2 antibody production.

For the current study, researchers reviewed the literature to evaluate cerebrospinal fluid (CSF) results from patients with coronavirus disease 2019 (COVID-19) who had neurological symptoms and had an MRI that showed (1) central nervous system (CNS) hyperintense lesions not attributed to ischemia and/or (2) leptomeningeal enhancement. The team sought to determine if these findings were associated with a positive CSF severe acute respiratory syndrome associated coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR).

They performed a systematic review of Medline and Embase from December 1, 2019 to November 18, 2020. CSF results were evaluated based on the presence/absence of (1) ≥ 1 CNS hyperintense lesion and (2) leptomeningeal enhancement.

Results highlighted the following facts.

• In 117 publications, we identified 193 patients with COVID-19 who had an MRI of the CNS and CSF testing.
• There were 125 (65%) patients with CNS hyperintense lesions. Patients with CNS hyperintense lesions were significantly more likely to have a positive CSF SARS-CoV-2 PCR (10% [9/87] vs. 0% [0/43], p = 0.029).
• Of 75 patients who had a contrast MRI, there were 20 (27%) patients who had leptomeningeal enhancement.
• Patients with leptomeningeal enhancement were significantly more likely to have a positive CSF SARS-CoV-2 PCR (25% [4/16] vs. 5% [2/42], p = 0.024).

"Based on this meta-analysis of data obtained from 193 patients withCOVID-19 described in the literature who had an MRI brain and/orspine and CSF testing as workup for neurologic symptoms, we found that the presence of CNS hyperintense lesions or leptomeningealenhancement on neuroimaging is associated with increased likelihoodof a positive CSF SARS-CoV-2 PCR. However, most patients withCOVID-19 who have CNS hyperintense lesions or leptomeningealenhancement do not have evidence of SARS-CoV-2 in the CSF, suggest-ing that these findings are the result of other processes, such as inflam-mation, hypoxia, or ischemia. The etiology for these i maging findingsshould be explored further via neuropathology studies."the team concluded.

For full article follow the link: https://doi.org/10.1111/jon.12880

Source:Journal of Neuroimaging