Cerebral hypoperfusion in post-COVID-19 cognitively impaired subjects revealed by arterial spin labeling MRI

• Published in: Scientific reports Vol. 13; no. 1; pp. 5808 - 9
• Main Authors: Ajčević, Miloš, Iscra, Katerina, Furlanis, Giovanni, Michelutti, Marco, Miladinović, Aleksandar, Buoite Stella, Alex, Ukmar, Maja, Cova, Maria Assunta, Accardo, Agostino, Manganotti, Paolo
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 10.04.2023; Nature Publishing Group; Nature Portfolio
• Subjects: 639/166/985; 692/617; Blood flow; Brain - blood supply; Brain - diagnostic imaging; Brain mapping; Cerebral blood flow; Cerebrovascular Circulation - physiology; Cognitive ability; Coronaviruses; Cortex (frontal); Cortex (parietal); COVID-19; COVID-19 - diagnostic imaging; Hemispheric laterality; Humanities and Social Sciences; Humans; Image processing; Long COVID; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; multidisciplinary; Neuroimaging; Neuroimaging - methods; Perfusion; Post-Acute COVID-19 Syndrome; SARS-CoV-2; Science; Science (multidisciplinary); Severe acute respiratory syndrome coronavirus 2; Spin labeling; Spin Labels; Statistical analysis; Temporal lobe
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-023-32275-3

Cognitive impairment is one of the most prevalent symptoms of post Severe Acute Respiratory Syndrome COronaVirus 2 (SARS-CoV-2) state, which is known as Long COVID. Advanced neuroimaging techniques may contribute to a better understanding of the pathophysiological brain changes and the underlying mechanisms in post-COVID-19 subjects. We aimed at investigating regional cerebral perfusion alterations in post-COVID-19 subjects who reported a subjective cognitive impairment after a mild SARS-CoV-2 infection, using a non-invasive Arterial Spin Labeling (ASL) MRI technique and analysis. Using MRI-ASL image processing, we investigated the brain perfusion alterations in 24 patients (53.0 ± 14.5 years, 15F/9M) with persistent cognitive complaints in the post COVID-19 period. Voxelwise and region-of-interest analyses were performed to identify statistically significant differences in cerebral blood flow (CBF) maps between post-COVID-19 patients, and age and sex matched healthy controls (54.8 ± 9.1 years, 13F/9M). The results showed a significant hypoperfusion in a widespread cerebral network in the post-COVID-19 group, predominantly affecting the frontal cortex, as well as the parietal and temporal cortex, as identified by a non-parametric permutation testing (p < 0.05, FWE-corrected with TFCE). The hypoperfusion areas identified in the right hemisphere regions were more extensive. These findings support the hypothesis of a large network dysfunction in post-COVID subjects with cognitive complaints. The non-invasive nature of the ASL-MRI method may play an important role in the monitoring and prognosis of post-COVID-19 subjects.