The cerebral network of COVID-19-related encephalopathy: a longitudinal voxel-based 18F-FDG-PET study

• Published in: European journal of nuclear medicine and molecular imaging Vol. 48; no. 8; pp. 2543 - 2557
• Main Authors: Kas, Aurélie, Soret, Marine, Pyatigoskaya, Nadya, Habert, Marie-Odile, Hesters, Adèle, Le Guennec, Loic, Paccoud, Olivier, Bombois, Stéphanie, Delorme, Cécile
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.07.2021; Springer Nature B.V; Springer Verlag (Germany) [1976-....]
• Subjects: Abnormalities; Brain; Brain Diseases; Cardiology; Caudate nucleus; Cerebrospinal fluid; Cognitive ability; Coronaviruses; Cortex (frontal); Cortex (insular); COVID-19; Deregulation; Disabilities; Disorders; Emotions; Encephalopathy; Fluorine isotopes; Fluorodeoxyglucose F18; Frontal lobe; Humans; Hypometabolism; Imaging; Life Sciences; Magnetic resonance imaging; Medicine; Medicine & Public Health; Neurology; Nuclear Medicine; Oncology; Orthopedics; Polymerase chain reaction; Positron emission; Positron emission tomography; Positron Emission Tomography Computed Tomography; Radiology; Respiratory failure; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Short Communication; Signs and symptoms; Substrates; Tomography; Viral diseases; COVID-19; Glucose metabolism; SARS-CoV-2; 18F-FDG-PET; Prefrontal impairment
• ISSN: 1619-7070; 1619-7089; 1619-7089
• DOI: 10.1007/s00259-020-05178-y

Purpose Little is known about the neuronal substrates of neuropsychiatric symptoms associated with COVID-19 and their evolution during the course of the disease. We aimed at describing the longitudinal brain metabolic pattern in COVID-19-related encephalopathy using 18F-FDG-PET/CT. Methods Seven patients with variable clinical presentations of COVID-19-related encephalopathy were explored thrice with brain 18F-FDG-PET/CT, once in the acute phase, 1 month later and 6 months after COVID-19 onset. PET images were analysed with voxel-wise and regions-of-interest approaches in comparison with 32 healthy controls. Results Patients’ neurological manifestations during acute encephalopathy were heterogeneous. However, all of them presented with predominant cognitive and behavioural frontal disorders. SARS-CoV-2 RT-PCR in the CSF was negative for all patients. MRI revealed no specific abnormalities for most of the subjects. All patients had a consistent pattern of hypometabolism in a widespread cerebral network including the frontal cortex, anterior cingulate, insula and caudate nucleus. Six months after COVID-19 onset, the majority of patients clinically had improved but cognitive and emotional disorders of varying severity remained with attention/executive disabilities and anxio-depressive symptoms, and lasting prefrontal, insular and subcortical 18F-FDG-PET/CT abnormalities. Conclusion The implication of this widespread network could be the neural substrate of clinical features observed in patients with COVID-19, such as frontal lobe syndrome, emotional disturbances and deregulation of respiratory failure perception. This study suggests that this network remains mildly to severely impaired 6 months after disease onset.