Cerebrovascular Complications and Vessel Wall Imaging in COVID-19 Encephalopathy—A Pilot Study

Abstract

Background and Purpose Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with several complications of the central nervous system (CNS), including acute encephalopathy. Methods In this pilot study, we report a series of 39 patients (66.5 ± 9.2 years; 10.3% female) with acute encephalopathy, who underwent a standard brain magnetic resonance imaging (MRI) at 1.5 T during the acute symptomatic phase. In addition to diffusion-weighted imaging, MR angiography and susceptibility-weighted images, high-resolution vascular black blood sequences (in 34 cases) were used to investigate the vasculature of the brain. Results In 29 out of 34 patients with COVID-19 encephalopathy (85%) with high-resolution vessel wall imaging, we found a circular enhancement and thickening of the basilar and vertebral arteries, without any correlation with ischemia or microbleeds (reported in 21% and 59%, respectively). Conclusion We report a high prevalence of vascular changes suggestive of endotheliitis as reported in other organs. This could suggest an inflammatory mechanism underlying this encephalopathy.

High-Resolution Black Blood Vessel Wall Imaging in COVID-19 Encephalopathy—Is it Really Endotheliitis?

“…1d and Fig 2a–c; bilateral vertebral arteries in Fig. 3d) of the addressed study [ 1 ] resemble the appearance of high-resolution vessel wall images from our non-vasculitic cohort (Fig. 2a–c, Fig.…”

“…with interest we read the study by Uginet et al. “Cerebrovascular Complications and Vessel Wall Imaging in COVID-19 Encephalopathy—A Pilot Study” [ 1 ]. They described the findings on high-resolution black blood vessel wall magnetic resonance imaging (MRI) at 1.5 T that was performed in 34 older patients (66.5 ± 9.2 years; 10.3% female) with coronavirus diseases 2019 (COVID-19) and acute encephalopathy in a retrospective observational study.…”

High-resolution intracranial vessel wall imaging in cerebral viral infections evaluations

“…Enhancements were also seen in left communicating ICA, proximal basilar artery, and left distal V4 VA, suggesting a multifocal or diffuse pattern of vasculopathy. VWI has been reported to detect vascular involvement in around 85% of cases of COVID-19 encephalopathy [ 13 ]. However, no significant correlation between infarction or hemorrhage with vessel wall enhancement was found.…”

“…Cheng-Ching et al have shown that VWI not only helps in diagnosis of varicella vasculopathy, but also has an immense role in guiding treatment duration and assessing treatment response [ 11 ]. Role of VWI in diagnosing vasculopathy in COVID-19, herpes encephalitis, HIV encephalopathy, and HCV encephalopathy have also been described in literature [ 5 , 13 – 15 ]. In this study, we aim to assess vascular complications of various viral CNS infections using high-resolution VWI, which may help to better understand the pathophysiology of secondary viral vasculitis and can have impact on management protocol.…”

COVID-19 associated intracranial vasculopathy–MRI vessel wall imaging as adjunct to emergent CT angiography—a case report

“…Recent studies have demonstrated abnormal findings on MRI vessel wall imaging (VWI) in hospitalized COVID-19 patients [3,5]. In addition, there is evidence that VWI complements conventional luminal imaging by increasing the reader's sensitivity for the detection of abnormalities, as well as augment the characterization these abnormalities [6]. Here, we report a case of intracranial inflammatory vasculopathy well demonstrated by vessel wall imaging (VWI), coincident with middle cerebral artery stroke, in a patient with COVID-19 and minimal pulmonary symptoms.…”