Neuroimaging Findings in Patients with COVID-19: A Systematic Review and Meta-Analysis

Pyeong Hwa Kim, Minjae Kim, Chong Hyun Suh, Sae Rom Chung, Ji Eun Park, Soo Chin Kim, Young Jun Choi, Jeong Hyun Lee, Ho Sung Kim, Jung Hwan Baek, Choong Gon Choi, Sang Joon Kim, Pyeong Hwa Kim, Minjae Kim, Chong Hyun Suh, Sae Rom Chung, Ji Eun Park, Soo Chin Kim, Young Jun Choi, Jeong Hyun Lee, Ho Sung Kim, Jung Hwan Baek, Choong Gon Choi, Sang Joon Kim

Abstract

Objective: Central nervous system involvement in coronavirus disease 2019 (COVID-19) has been increasingly reported. We performed a systematic review and meta-analysis to evaluate the incidence of radiologically demonstrated neurologic complications and detailed neuroimaging findings associated with COVID-19.

Materials and methods: A systematic literature search of MEDLINE/PubMed and EMBASE databases was performed up to September 17, 2020, and studies evaluating neuroimaging findings of COVID-19 using brain CT or MRI were included. Several cohort-based outcomes, including the proportion of patients with abnormal neuroimaging findings related to COVID-19 were evaluated. The proportion of patients showing specific neuroimaging findings was also assessed. Subgroup analyses were also conducted focusing on critically ill COVID-19 patients and results from studies that used MRI as the only imaging modality.

Results: A total of 1394 COVID-19 patients who underwent neuroimaging from 17 studies were included; among them, 3.4% of the patients demonstrated COVID-19-related neuroimaging findings. Olfactory bulb abnormalities were the most commonly observed (23.1%). The predominant cerebral neuroimaging finding was white matter abnormality (17.6%), followed by acute/subacute ischemic infarction (16.0%), and encephalopathy (13.0%). Significantly more critically ill patients had COVID-19-related neuroimaging findings than other patients (9.1% vs. 1.6%; p = 0.029). The type of imaging modality used did not significantly affect the proportion of COVID-19-related neuroimaging findings.

Conclusion: Abnormal neuroimaging findings were occasionally observed in COVID-19 patients. Olfactory bulb abnormalities were the most commonly observed finding. Critically ill patients showed abnormal neuroimaging findings more frequently than the other patient groups. White matter abnormalities, ischemic infarctions, and encephalopathies were the common cerebral neuroimaging findings.

Keywords: COVID-19; Computed tomography; Magnetic resonance imaging; Meta-analysis; Neuroimaging.

Conflict of interest statement

The authors have no potential conflicts of interest to disclose.

Copyright © 2021 The Korean Society of Radiology.

Figures

Fig. 1. Venn diagram illustrating the cohort-based…
Fig. 1. Venn diagram illustrating the cohort-based outcomes used in this study.
1) proportion of patients with NS among all COVID-19 patients (NS/C); 2) proportion of patients with NI among patients with NI-NS; 3) proportion of patients who underwent NI among all patients assessed (NI/C); 4) proportion of patients with any NI findings among the patients who underwent NI (NF/NI); 5) proportion of patients with NFC among the patients who underwent NI (NFC/NI); 6) proportion of patients with NFC among all patients assessed (NFC/C). COVID-19 = coronavirus disease 2019, NF = NI findings, NFC = NF related to COVID-19, NI = neuroimaging, NS = neurologic symptoms
Fig. 2. Flow chart depicting the study…
Fig. 2. Flow chart depicting the study selection process.
Fig. 3. Forest plots representing the proportion…
Fig. 3. Forest plots representing the proportion of the patients with specific neuroimaging findings among the patients who underwent neuroimaging studies.
Pooled estimates with 95% CIs were determined using DerSimonian-Laird random-effects modeling. CI = confidence interval

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