Neuroimaging findings.

Introduction
Coronavirus 2019 (COVID-19) is known to affect the central nervous system. Neurologic morbidity associated with COVID-19 is commonly attributed to sequelae of some combination of thrombotic and inflammatory processes. The aim of this retrospective observational study was to evaluate neuroimaging findings in hospitalized COVID-19 patients with neurological manifestations in cancer versus non-cancer patients, and in patients with versus without ventilatory support (with ventilatory support defined as including patients with intubation and noninvasive ventilation). Cancer patients are frequently in an immunocompromised or prothrombotic state with side effects from chemotherapy and radiation that may cause neurological issues and increase vulnerability to systemic illness. We wanted to determine whether neurological and/or neuroimaging findings differed between patients with and without cancer.
Methods
Eighty adults (44 male, 36 female, 64.5 ±14 years) hospitalized in the Mount Sinai Health System in New York City between March 2020 and April 2021 with reverse-transcriptase polymerase chain reaction-confirmed COVID-19 underwent magnetic resonance imaging (MRI) during their admissions. The cohort consisted of four equal subgroups based on cancer and ventilatory support status. Clinical and imaging data were acquired and analyzed.
Results
Neuroimaging findings included non-ischemic parenchymal T2/FLAIR signal hyperintensities (36.3%), acute/subacute infarcts (26.3%), chronic infarcts (25.0%), microhemorrhages (23.8%), chronic macrohemorrhages (10.0%), acute macrohemorrhages (7.5%), and encephalitis-like findings (7.5%). There were no significant differences in neuroimaging findings between cancer and non-cancer subgroups. Clinical neurological manifestations varied. The most common was encephalopathy (77.5%), followed by impaired responsiveness/coma (38.8%) and stroke (26.3%). There were significant differences between patients with versus without ventilatory support. Encephalopathy and impaired responsiveness/coma were more prevalent in patients with ventilatory support (p = 0.02). Focal weakness was more frequently seen in patients without ventilatory support (p = 0.01).
Discussion
This study suggests COVID-19 is associated with neurological manifestations that may be visible with brain imaging techniques such as MRI. In our COVID-19 cohort, there was no association between cancer status and neuroimaging findings. Future studies might include more prospectively enrolled systematically characterized patients, allowing for more rigorous statistical analysis.

引言
新型冠状病毒肺炎（Coronavirus 2019, COVID-19）已知可累及中枢神经系统。与COVID-19相关的神经系统并发症通常归因于血栓形成与炎症反应过程共同介导的后遗症。本回顾性观察研究旨在评估伴有神经系统表现的住院COVID-19患者的神经影像学表现，对比癌症患者与非癌症患者、接受呼吸支持治疗与未接受呼吸支持治疗患者的差异（呼吸支持治疗定义包括气管插管患者与无创通气患者）。癌症患者常处于免疫功能低下或血栓前状态，化疗与放疗的不良反应可能诱发神经系统问题，并增加全身疾病易感性。本研究旨在明确伴与不伴癌症的患者之间，神经系统及/或神经影像学表现是否存在差异。

方法
80名成年患者（男性44例，女性36例，年龄64.5±14岁）于2020年3月至2021年4月间在纽约市西奈山医疗系统（Mount Sinai Health System）住院，经逆转录聚合酶链反应（reverse-transcriptase polymerase chain reaction, RT-PCR）确认感染COVID-19，且在住院期间接受了磁共振成像（magnetic resonance imaging, MRI）检查。本队列根据癌症状态与呼吸支持情况分为4个等规模亚组。研究人员收集并分析了患者的临床与影像学数据。

结果
神经影像学表现包括：非缺血性脑实质T2/液体衰减反转恢复（fluid-attenuated inversion recovery, FLAIR）序列信号高信号（36.3%）、急性/亚急性脑梗死（26.3%）、慢性脑梗死（25.0%）、微出血灶（23.8%）、慢性大出血灶（10.0%）、急性大出血灶（7.5%）及脑炎样影像学表现（7.5%）。癌症与非癌症亚组间的神经影像学表现无显著差异。临床神经系统表现多样，最常见的为脑病（77.5%），其次为反应迟钝/昏迷（38.8%）与脑卒中（26.3%）。接受与未接受呼吸支持治疗的患者间存在显著差异：接受呼吸支持治疗的患者中脑病、反应迟钝/昏迷的发生率更高（p=0.02）；未接受呼吸支持治疗的患者局灶性肌无力更为多见（p=0.01）。

讨论
本研究表明，COVID-19与神经系统表现相关，此类表现可通过磁共振成像等脑影像学技术检出。在本COVID-19队列中，癌症状态与神经影像学表现无关联。未来的研究可纳入更多前瞻性入组、系统评估特征的患者，以开展更严谨的统计学分析。