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Time-dependent recovery of brain hypometabolism in neuro-COVID-19 patients

PURPOSE: We evaluated brain metabolic dysfunctions and associations with neurological and biological parameters in acute, subacute and chronic COVID-19 phases to provide deeper insights into the pathophysiology of the disease. METHODS: Twenty-six patients with neurological symptoms (neuro-COVID-19)...

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Autores principales: Martini, Anna Lisa, Carli, Giulia, Kiferle, Lorenzo, Piersanti, Patrizia, Palumbo, Pasquale, Morbelli, Silvia, Calcagni, Maria Lucia, Perani, Daniela, Sestini, Stelvio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9388976/
https://www.ncbi.nlm.nih.gov/pubmed/35984451
http://dx.doi.org/10.1007/s00259-022-05942-2
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author Martini, Anna Lisa
Carli, Giulia
Kiferle, Lorenzo
Piersanti, Patrizia
Palumbo, Pasquale
Morbelli, Silvia
Calcagni, Maria Lucia
Perani, Daniela
Sestini, Stelvio
author_facet Martini, Anna Lisa
Carli, Giulia
Kiferle, Lorenzo
Piersanti, Patrizia
Palumbo, Pasquale
Morbelli, Silvia
Calcagni, Maria Lucia
Perani, Daniela
Sestini, Stelvio
author_sort Martini, Anna Lisa
collection PubMed
description PURPOSE: We evaluated brain metabolic dysfunctions and associations with neurological and biological parameters in acute, subacute and chronic COVID-19 phases to provide deeper insights into the pathophysiology of the disease. METHODS: Twenty-six patients with neurological symptoms (neuro-COVID-19) and [(18)F]FDG-PET were included. Seven patients were acute (< 1 month (m) after onset), 12 subacute (4 ≥ 1-m, 4 ≥ 2-m and 4 ≥ 3-m) and 7 with neuro-post-COVID-19 (3 ≥ 5-m and 4 ≥ 7–9-m). One patient was evaluated longitudinally (acute and 5-m). Brain hypo- and hypermetabolism were analysed at single-subject and group levels. Correlations between severity/extent of brain hypo- and hypermetabolism and biological (oxygen saturation and C-reactive protein) and clinical variables (global cognition and Body Mass Index) were assessed. RESULTS: The “fronto-insular cortex” emerged as the hypometabolic hallmark of neuro-COVID-19. Acute patients showed the most severe hypometabolism affecting several cortical regions. Three-m and 5-m patients showed a progressive reduction of hypometabolism, with limited frontal clusters. After 7–9 months, no brain hypometabolism was detected. The patient evaluated longitudinally showed a diffuse brain hypometabolism in the acute phase, almost recovered after 5 months. Brain hypometabolism correlated with cognitive dysfunction, low blood saturation and high inflammatory status. Hypermetabolism in the brainstem, cerebellum, hippocampus and amygdala persisted over time and correlated with inflammation status. CONCLUSION: Synergistic effects of systemic virus-mediated inflammation and transient hypoxia yield a dysfunction of the fronto-insular cortex, a signature of CNS involvement in neuro-COVID-19. This brain dysfunction is likely to be transient and almost reversible. The long-lasting brain hypermetabolism seems to reflect persistent inflammation processes. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00259-022-05942-2.
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spelling pubmed-93889762022-08-19 Time-dependent recovery of brain hypometabolism in neuro-COVID-19 patients Martini, Anna Lisa Carli, Giulia Kiferle, Lorenzo Piersanti, Patrizia Palumbo, Pasquale Morbelli, Silvia Calcagni, Maria Lucia Perani, Daniela Sestini, Stelvio Eur J Nucl Med Mol Imaging Original Article PURPOSE: We evaluated brain metabolic dysfunctions and associations with neurological and biological parameters in acute, subacute and chronic COVID-19 phases to provide deeper insights into the pathophysiology of the disease. METHODS: Twenty-six patients with neurological symptoms (neuro-COVID-19) and [(18)F]FDG-PET were included. Seven patients were acute (< 1 month (m) after onset), 12 subacute (4 ≥ 1-m, 4 ≥ 2-m and 4 ≥ 3-m) and 7 with neuro-post-COVID-19 (3 ≥ 5-m and 4 ≥ 7–9-m). One patient was evaluated longitudinally (acute and 5-m). Brain hypo- and hypermetabolism were analysed at single-subject and group levels. Correlations between severity/extent of brain hypo- and hypermetabolism and biological (oxygen saturation and C-reactive protein) and clinical variables (global cognition and Body Mass Index) were assessed. RESULTS: The “fronto-insular cortex” emerged as the hypometabolic hallmark of neuro-COVID-19. Acute patients showed the most severe hypometabolism affecting several cortical regions. Three-m and 5-m patients showed a progressive reduction of hypometabolism, with limited frontal clusters. After 7–9 months, no brain hypometabolism was detected. The patient evaluated longitudinally showed a diffuse brain hypometabolism in the acute phase, almost recovered after 5 months. Brain hypometabolism correlated with cognitive dysfunction, low blood saturation and high inflammatory status. Hypermetabolism in the brainstem, cerebellum, hippocampus and amygdala persisted over time and correlated with inflammation status. CONCLUSION: Synergistic effects of systemic virus-mediated inflammation and transient hypoxia yield a dysfunction of the fronto-insular cortex, a signature of CNS involvement in neuro-COVID-19. This brain dysfunction is likely to be transient and almost reversible. The long-lasting brain hypermetabolism seems to reflect persistent inflammation processes. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00259-022-05942-2. Springer Berlin Heidelberg 2022-08-19 2022 /pmc/articles/PMC9388976/ /pubmed/35984451 http://dx.doi.org/10.1007/s00259-022-05942-2 Text en © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2022, Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Original Article
Martini, Anna Lisa
Carli, Giulia
Kiferle, Lorenzo
Piersanti, Patrizia
Palumbo, Pasquale
Morbelli, Silvia
Calcagni, Maria Lucia
Perani, Daniela
Sestini, Stelvio
Time-dependent recovery of brain hypometabolism in neuro-COVID-19 patients
title Time-dependent recovery of brain hypometabolism in neuro-COVID-19 patients
title_full Time-dependent recovery of brain hypometabolism in neuro-COVID-19 patients
title_fullStr Time-dependent recovery of brain hypometabolism in neuro-COVID-19 patients
title_full_unstemmed Time-dependent recovery of brain hypometabolism in neuro-COVID-19 patients
title_short Time-dependent recovery of brain hypometabolism in neuro-COVID-19 patients
title_sort time-dependent recovery of brain hypometabolism in neuro-covid-19 patients
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9388976/
https://www.ncbi.nlm.nih.gov/pubmed/35984451
http://dx.doi.org/10.1007/s00259-022-05942-2
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