A comprehensive review of imaging findings in COVID-19 - status in early 2021

Abstract

Medical imaging methods are assuming a greater role in the workup of patients with COVID-19, mainly in relation to the primary manifestation of pulmonary disease and the tissue distribution of the angiotensin-converting-enzyme 2 (ACE 2) receptor. However, the field is so new that no consensus view has emerged guiding clinical decisions to employ imaging procedures such as radiography, computer tomography (CT), positron emission tomography (PET), and magnetic resonance imaging, and in what measure the risk of exposure of staff to possible infection could be justified by the knowledge gained. The insensitivity of current RT-PCR methods for positive diagnosis is part of the rationale for resorting to imaging procedures. While CT is more sensitive than genetic testing in hospitalized patients, positive findings of ground glass opacities depend on the disease stage. There is sparse reporting on PET/CT with [18F]-FDG in COVID-19, but available results are congruent with the earlier literature on viral pneumonias. There is a high incidence of cerebral findings in COVID-19, and likewise evidence of gastrointestinal involvement. Artificial intelligence, notably machine learning is emerging as an effective method for diagnostic image analysis, with performance in the discriminative diagnosis of diagnosis of COVID-19 pneumonia comparable to that of human practitioners.

Pathophysiology of Cardiac Injury in COVID-19 Patients with Acute Ischaemic Stroke: What Do We Know So Far?—A Review of the Current Literature

“…However, there are several investigations that promote a neural pathway whereby SARS-CoV-2 pathology propagates to the brain as well. Among postulates, a neuronal route via afferent olfactory nerves and transsynaptic spread (endo-/exocytosis) has been frequently discussed [44,46]. This might be a complementary mechanism contributing to stroke risk by inducing brain damage and vulnerability in COVID-19 patients.…”

COVID-19: neurologische Manifestationen – Update

“…Eine weitere aktuelle Studie berichtete über eine beinah vollständige Rückbildung der Geruchs- und Geschmacksstörungen nach einem Jahr [ 35 ]. Magnetresonanztomographie(MRT)-Untersuchungen stellten in manchen Fällen eine Atrophie und T2-Signalerhöhung im Riechkolben fest, die ebenso wie die Symptome der meisten Patienten rückläufig waren [ 1 , 34 ].…”

“…Abgesehen von hämorrhagischen Schlaganfällen im Sinne intrazerebraler Makroblutungen, seien ebenfalls Mikroblutungen genannt, die in Neuroimaging-Studien erfasst wurden [ 1 , 34 ]. Ob diese jedoch tatsächlich COVID-19-assoziiert waren oder schon vorbestanden, kann derzeit bei fehlender Studienlage nicht beantwortet werden [ 1 ].…”

“…Das Spektrum gemeldeter Fälle erstreckt sich von einer Enzephalitis, die häufig im Temporallappen lokalisiert ist, über akute disseminierte Enzephalomyelitis (ADEM), akuter nekrotisierender Enzephalitis oder auch Myelitis [ 1 , 34 ]. Ein negativer Liquorbefund und bildmorphologischer MRT-Befund schließen die Diagnose nicht aus [ 1 , 34 ].…”

“…Das Neuroimaging-Muster spiegelt u. a. Folgen einer Hypoxie, thromboembolischer Ereignisse und die einer Neuroinflammation wider. Keine dieser Befunde sind jedoch spezifisch [ 1 , 13 , 21 , 30 ].…”