Susceptibility-weighted imaging reveals cerebral microvascular injury in severe COVID-19.

Jan 28, 2021

Contributor: John Conklin,Matthew P Frosch,Shibani S Mukerji,Otto Rapalino,Mary D Maher,Pamela W Schaefer,Michael H Lev,R G Gonzalez,Sudeshna Das,Samantha N Champion,Colin Magdamo,Pritha Sen,G Kyle Harrold,Haitham Alabsi,Erica Normandin,Bennett Shaw,Jacob E Lemieux,Pardis C Sabeti,John A Branda,Emery N Brown,M Brandon Westover,Susie Y Huang,Brian L Edlow

Susceptibility-weighted imaging reveals cerebral microvascular injury in severe COVID-19.

We evaluated the incidence, distribution, and histopathologic correlates of microvascular brain lesions in patients with severe COVID-19. Sixteen consecutive patients admitted to the intensive care unit with severe COVID-19 undergoing brain MRI for evaluation of coma or neurologic deficits were retrospectively identified. Eleven patients had punctate susceptibility-weighted imaging (SWI) lesions in the subcortical and deep white matter, eight patients had >10 SWI lesions, and four patients had lesions involving the corpus callosum. The distribution of SWI lesions was similar to that seen in patients with hypoxic respiratory failure, sepsis, and disseminated intravascular coagulation. Brain autopsy in one patient revealed that SWI lesions corresponded to widespread microvascular injury, characterized by perivascular and parenchymal petechial hemorrhages and microscopic ischemic lesions. Collectively, these radiologic and histopathologic findings add to growing evidence that patients with severe COVID-19 are at risk for multifocal microvascular hemorrhagic and ischemic lesions in the subcortical and deep white matter.

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About The Expert

John Conklin

Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States of America.

Matthew P Frosch

C.S. Kubik Laboratory for Neuropathology, Massachusetts General Hospital, Boston, MA, USA; Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America.

Shibani S Mukerji

Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America.

Otto Rapalino

Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America.

Mary D Maher

Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America.

Pamela W Schaefer

Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America.

Michael H Lev

Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America.

R G Gonzalez

Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America.

Sudeshna Das

Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America.

Samantha N Champion

C.S. Kubik Laboratory for Neuropathology, Massachusetts General Hospital, Boston, MA, USA.

Colin Magdamo

Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America.

Pritha Sen

Division of Infectious Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America.

G Kyle Harrold

Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America.

Haitham Alabsi

Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America.

Erica Normandin

Broad Institute, Massachusetts Institute of Technology and Harvard University, Cambridge, MA, United States of America.

Bennett Shaw

Division of Infectious Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America; Broad Institute, Massachusetts Institute of Technology and Harvard University, Cambridge, MA, United States of America.

Jacob E Lemieux

Division of Infectious Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America.

Pardis C Sabeti

Broad Institute, Massachusetts Institute of Technology and Harvard University, Cambridge, MA, United States of America.

John A Branda

Department of Pathology, Massachusetts General Hospital and Harvard Medical School, United States of America.

Emery N Brown

Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America.

M Brandon Westover

Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America.

Susie Y Huang

Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States of America.

Brian L Edlow

Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States of America; Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA, United States of America; Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America. Electronic address: bedlow@mgh.harvard.edu.

References

PubMed