Characterizing the effects of COVID‐19 on the brain using FDG PET imaging before and after COVID‐19 infection
Steven Bishay, Trent Schwartz, David Samuel Smith, Lok Hin Lee, Sonya Reid, Timothy J. Hohman, Angela L. Jefferson, Jeremy Warner, Mary Ellen Koran- Psychiatry and Mental health
- Cellular and Molecular Neuroscience
- Geriatrics and Gerontology
- Neurology (clinical)
- Developmental Neuroscience
- Health Policy
- Epidemiology
Abstract
Background
Individuals diagnosed with COVID‐19 have been found to have changes in brain structure as well as dramatic neuropsychiatric effects such as dementia, Parkinsonism, and greater likelihood of stroke (Taquet, 2021). Infection has also been shown to result in hypometabolic changes on 18F ‐fluorodeoxyglucose positron emission tomography (FDG PET) when compared to normal controls (Guedj, 2021). This study will seek to determine which brain regions are most affected by COVID‐19 with FDG PET. To our knowledge, we are the first study to compare pre‐ and post‐infection FDG PET imaging within patients. These patients were coincidentally infected with COVID‐19 between standard of care longitudinal FDG PET imaging for cancer.
Method
Patients with COVID‐19 who had FDG PET imaging that included the brain before and after serologic COVID‐19 diagnosis were identified from an internal COVID‐19 registry. Clinical data was mined from the electronic health record. Images were processed with well‐established SPM12 methods (Friston, 1995). A voxel‐wise ANCOVA was performed on FDG PET images before and after COVID‐19 infection, including covariates of age, sex, ethnicity, and time between chemotherapy and follow‐up imaging using p < 0.001 and voxel extent threshold of 10.
Result
29 patients met inclusion criteria (Table 1). Compared to baseline, 4 clusters of voxels were significantly decreased after COVID‐19 infection in the temporal lobes, anterior cingulate gyrus, and superior cerebellum (Table 2). In a post‐hoc analysis, spherical regions of interest (radius = 5 mm) surrounding these clusters were tested for post‐infection hypometabolism. The bilateral temporal lobes, anterior lobe of cerebellum, and right caudate head showed significant decrease in glucose metabolism following COVID‐19 infection (p < 0.05).
Conclusion
Currently, this is the first study to leverage a pre‐COVID‐19 infection FDG PET for comparison to imaging post‐infection. We discovered regions in the temporal lobe, frontal lobe, and cerebellum that showed hypometabolic changes following infection, important for determining spatial localization of the effects of this viral infection.