Can diffusion tensor imaging (DTI) outperform standard magnetic resonance imaging (MRI) investigations in post-COVID-19 autoimmune encephalitis?

DOI: https://doi.org/10.48101/ujms.v127.8562
Keywords: COVID-19, white matter, encephalitis, DTI, MRI

Abstract

Background: Neurological and psychiatric manifestations related to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection are widely recognised. Standard magnetic resonance imaging (MRI) investigations are normal in 40–80% of symptomatic patients, eventually delaying appropriate treatment when MRI is unrevealing any structural changes. The aim of this study is to investigate white matter abnormalities during an early stage of post-COVID-19 (coronavirus disease 2019) encephalitis while conventional MRI was normal.

Methods: A patient with post-COVID-19 autoimmune encephalitis was investigated by serial MRIs and diffusion tensor imaging (DTI). Ten healthy control individuals (HC) were utilised as a control group for the DTI analysis. Major projection, commissural and association white matter pathways were reconstructed, and multiple diffusion parameters were analysed and then compared to the HC average using a z-test for serial examinations.

Results: Eleven days after the onset of neurological symptoms, DTI revealed early white matter changes, compared with HC, when standard MRI was normal. On day 68, DTI showed multiple white matter lesions compared with HC, visible at this time also by the MRI images, indicating inflammatory changes in different association and projection white matter pathways.

Conclusion: We confirm a limitation in the sensitivity of conventional MRI at the acute setting of post-COVID-19 autoimmune encephalitis. A complementary DTI investigation could be a valuable diagnostic tool in early therapeutic decisions concerning COVID-19-related neurological symptoms.

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References


  1. Pezzini A, Padovani A. Lifting the mask on neurological manifestations of COVID-19. Nat Rev Neurol. 2020 Nov;16:636–44. doi: 10.1038/s41582-020-0398-3

  2. Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020 Jun 1;77:683–90. doi: 10.1001/jamaneurol.2020.1127

  3. Helms J, Kremer S, Merdji H, Clere-Jehl R, Schenck M, Kummerlen C, et al. Neurologic features in severe SARS-CoV-2 infection. N Engl J Med. 2020 Jun 4;382:2268–70. doi: 10.1056/NEJMc2008597

  4. Romoli M, Jelcic I, Bernard‐Valnet R, García Azorín D, Mancinelli L, Akhvlediani T, et al. A systematic review of neurological manifestations of SARS‐CoV‐2 infection: the devil is hidden in the details. Eur J Neurol. 2020 Sep;27:1712–26. doi: 10.1111/ene.14382

  5. Katal S, Balakrishnan S, Gholamrezanezhad A. Neuroimaging and neurologic findings in COVID-19 and other coronavirus infections: a systematic review in 116 patients. J Neuroradiol. 2021 Feb 1;48:43–50. doi: 10.1016/j.neurad.2020.06.007

  6. Kandemirli SG, Dogan L, Sarikaya ZT, Kara S, Akinci C, Kaya D, et al. Brain MRI findings in patients in the intensive care unit with COVID-19 infection. Radiology. 2020 May 8;297:E232–5. doi: 10.1148/radiol.2020201697

  7. Pilotto A, Masciocchi S, Volonghi I, Crabbio M, Magni E, De Giuli V, et al. Clinical presentation and outcomes of severe acute respiratory syndrome coronavirus 2-related encephalitis: the ENCOVID multicenter study. J Infect Dis. 2021 Jan 4;223:28–37. doi: 10.1093/infdis/jiaa609

  8. Paterson RW, Brown RL, Benjamin L, Nortley R, Wiethoff S, Bharucha T, et al. The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings. Brain. 2020 Oct 1;143:3104–20.

  9. Kremer S, Lersy F, de Sèze J, Ferré J-C, Maamar A, Carsin-Nicol B, et al. Brain MRI findings in severe COVID-19: a retrospective observational study. Radiology. 2020 Nov;297:E242–51.

  10. Horsfield MA, Jones DK. Applications of diffusion-weighted and diffusion tensor MRI to white matter diseases – a review. NMR Biomed. 2002;15:570–7. doi: 10.1002/nbm.787

  11. Meoded A, Poretti A, Mori S, Zhang J. Diffusion Tensor Imaging (DTI)☆. In: Reference module in neuroscience and biobehavioral psychology. Elsevier; 2017 [cited 2021 Jan 22]. Available from: http://www.sciencedirect.com/science/article/pii/B978012809324502472X

  12. Shin SS, Pathak S, Presson N, Bird W, Wagener L, Schneider W, et al. Detection of white matter injury in concussion using high-definition fiber tractography. Prog Neurol Surg. 2014;28:86–93. doi: 10.1159/000358767

  13. Gimenez U, Perles-Barbacaru A-T, Millet A, Appaix F, El-Atifi M, Pernet-Gallay K, et al. Microscopic DTI accurately identifies early glioma cell migration: correlation with multimodal imaging in a new glioma stem cell model. NMR Biomed. 2016;29:1553–62. doi: 10.1002/nbm.3608

  14. Ragin AB, Wu Y, Gao Y, Keating S, Du H, Sammet C, et al. Brain alterations within the first 100 days of HIV infection. Ann Clin Transl Neurol. 2015;2:12–21. doi: 10.1002/acn3.136

  15. Herweh C, Jayachandra M, Hartmann M, Gass A, Sellner J, Heiland S, et al. Quantitative diffusion tensor imaging in herpes simplex virus encephalitis. J Neurovirol. 2007 Jan;13:426–32. doi: 10.1080/13550280701456498

  16. Lu Y, Li X, Geng D, Mei N, Wu P-Y, Huang C-C, et al. Cerebral micro-structural changes in COVID-19 patients – an MRI-based 3-month follow-up study. EClinicalMedicine. 2020;25:100484. doi: 10.1016/j.eclinm.2020.100484

  17. Mulder J, Feresiadou A, Fällmar D, Frithiof R, Virhammar J, Rasmusson A, et al. Autoimmune encephalitis presenting with malignant catatonia in a 40-year-old male patient with Covid-19. Am J Psychiatry. 2021 Jun;178(6):485–489. doi: 10.1176/appi.ajp.2020.20081236

  18. Latini F, Fahlström M, Marklund N, Feresiadou A. White matter abnormalities in a patient with visual snow syndrome: new evidence from a diffusion tensor imaging study. Eur J Neurol. 2021 Aug;28:2789–93. doi: 10.1111/ene.14903

  19. Latini F, Fahlström M, Vedung F, Stensson S, Larsson E-M, Lubberink M, et al. Refined analysis of chronic white matter changes after traumatic brain injury and repeated sports-related concussions: of use in targeted rehabilitative approaches? J Clin Med. 2022 Jan 12;11:358. doi: 10.3390/jcm11020358

  20. Radmanesh A, Derman A, Lui YW, Raz E, Loh JP, Hagiwara M, et al. COVID-19–associated diffuse leukoencephalopathy and microhemorrhages. Radiology. 2020 May 21;297:E223–7. doi: 10.1148/radiol.2020202040

  21. Xiong W, Mu J, Guo J, Lu L, Liu D, Luo J, et al. New onset neurologic events in people with COVID-19 in 3 regions in China. Neurology. 2020 Sep 15;95:e1479–87. doi: 10.1212/WNL.0000000000010034

  22. Arbour N, Day R, Newcombe J, Talbot PJ. Neuroinvasion by human respiratory coronaviruses. J Virol. 2000 Oct 1;74:8913–21. doi: 10.1128/JVI.74.19.8913-8921.2000

  23. Bender SJ, Weiss SR. Pathogenesis of murine coronavirus in the central nervous system. J Neuroimmune Pharmacol. 2010 Sep;5:336–54. doi: 10.1007/s11481-010-9202-2

  24. Desforges M, Le Coupanec A, Dubeau P, Bourgouin A, Lajoie L, Dubé M, et al. Human coronaviruses and other respiratory viruses: underestimated opportunistic pathogens of the central nervous system? Viruses. 2019 Dec 20;12:14. doi: 10.3390/v12010014

  25. Winklewski PJ, Sabisz A, Naumczyk P, Jodzio K, Szurowska E, Szarmach A. Understanding the physiopathology behind axial and radial diffusivity changes – what do we know? Front Neurol. 2018;9:92. doi: 10.3389/fneur.2018.00092

  26. Schurink B, Roos E, Radonic T, Barbe E, Bouman CSC, de Boer HH, et al. Viral presence and immunopathology in patients with lethal COVID-19: a prospective autopsy cohort study. Lancet Microbe. 2020 Nov;1:e290–9. doi: 10.1016/S2666-5247(20)30144-0

Published
2022-05-10
How to Cite
Latini F., Fahlström M., Fällmar D., Marklund N., Cunningham J. L., & Feresiadou A. (2022). Can diffusion tensor imaging (DTI) outperform standard magnetic resonance imaging (MRI) investigations in post-COVID-19 autoimmune encephalitis?. Upsala Journal of Medical Sciences, 127(1). https://doi.org/10.48101/ujms.v127.8562
Issue
Vol. 127 (2022): Upsala J Med Sci
Section
Short Reports
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