Muhammad G. Saleh¹, Linda Chang^1,2,3, Huajun Liang¹, Meghann C Ryan¹, Eric Cunningham¹, Eleanor Wilson⁴, Andrea R Levine⁵, Shyamasundaran Kottilil⁵, and Thomas Ernst^1
1Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, United States, ²Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, United States, ³Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States, ⁴Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States, ⁵Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States

COVID-19 infection was associated with lower plasma levels of glutathione (GSH), provoking oxidative stress; however, whether GSH levels are also lower in the brain is unknown. COVID-19 survivors (COVID+) also have higher prevalence of psychiatric disorders, possibly due to altered brain GABA. However, brain GABA and GSH levels have not been assessed in convalescent COVID-19 (COVID+) individuals. Using edited MRS, frontal grey matter (FGM) GSH were lower in male COVID+, and COVID+ individuals had greater age-related decline in FGM GSH, compared to uninfected controls. These findings suggest that male COVID+ individuals, especially the older subjects, are susceptible to oxidative stress.

Christina Maher^1,2, Arkiev D'Souza¹, Michael Barnett^1,3,4, Omid Kavehei^2,5, Armin Nikpour⁴, and Chenyu Wang^1,3
1Brain and Mind Centre, The University of Sydney, Sydney, Australia, ²School of Biomedical Engineering, Faculty of Engineering, University of Sydney, Sydney, Australia, ³Sydney Neuroimaging and Analysis Centre, Sydney, Australia, ⁴Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia, ⁵ARC Centre for Innovative Bioengineering, The University of Sydney, Sydney, Australia

Focal to bilateral tonic-clonic seizures (FBTCS) are a feature of focal epilepsy, characterised by seizures that spread contralaterally to the origin of ictal discharge. Widespread global network disruption has been shown in patients with FBTCS compared to those with focal epilepsy. A structure-function relationship has been proposed, suggesting the role of the underlying subcortical structures in network alterations. Disease duration has been associated with whole-brain network disruption. Global network disruption may be a subtle marker in differentiating the likelihood of developing FBTCS, allowing treatment to be tailored.

Maoxue Wang¹, Jilei Zhang², and Bing Zhang^3
1The Affiliated Drum Tower Hospital of Nanjing University Medical School, nanjing, China, ²Philips Healthcare, Shanghai, China, ³The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China

Little is known of distal internal carotid artery (ICA) hemodynamics in patients with moyamoya angiopathy (MMA) and its relationship with cerebrovascular events. In this study, distal ICA hemodynamics were analyzed using 4D Flow MRI in 70 MMA patients (61 infarct hemispheres and 63 non-infarct hemipheres). V_max was found to be associated with cerebrovascular event in MMA patients.

Ivan I. Maximov^1,2, Dennis van der Meer^2,3,4, Ann-Marie de Lange^2,3,5, and Lars T Westlye^2,3
1Western Norway University of Applied Sciences, Bergen, Norway, ²NORMENT, Oslo University Hospital, Oslo, Norway, ³University of Oslo, Oslo, Norway, ⁴Maastricht University, Maastricht, Netherlands, ⁵Lausanne University Hospital, Lausanne, Switzerland

The COVID-19 pandemic has caused a global health crisis. There are a few indications that this disease has harmful consequences on neurological functioning, besides brain changes following COVID-19 infection have not yet been fully understood. Here, we used UK Biobank (UKB) longitudinal diffusion MRI data acquired before and after COVID-19 tests along the ongoing UKB study. We evaluated brain age gap metrics for the participants with positive and negative test results in order to evaluate COVID-19 consequences on the brain.

Eleanor F Cox¹, Tomas Luther², Per Eckerbom³, Jan Weis⁴, Fredrik Palm⁵, Robert Frithiof², Per Liss³, and Susan T Francis^1
1Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, United Kingdom, ²Section of Anesthesiology, Dept of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden, ³Section of Radiology, Dept of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden, ⁴Department of Medical Physics, Uppsala University Hospital, Uppsala, Sweden, ⁵Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden

Acute kidney injury (AKI) is associated with increased mortality in COVID-19 patients. Multiparametric MRI was performed to study renal perfusion, oxygenation and tissue structure in nineteen COVID-19 intensive care patients. Results are compared between patients with and without COVID-19 associated AKI, and with healthy volunteers (HV). Cortical perfusion was lower in COVID-19 compared to HVs (P=0.0002) with cortex and medullary perfusion lower in AKI compared to non-AKI (P<0.03). Correlations between cortex measures in COVID-19 showed T₁ was positively correlated with T₂ and ADC, and T₂ was positively correlated with ADC and T₂* suggesting interstitial oedema resulting from inflammation.

Shams Rashid^1,2, Oleksandr Khegai¹, Nathalie Jette³, Puneet Belani¹, Puneet Pawha¹, Sera Saju¹, Allison Navis³, Brian Mathew³, Jonathan Goldstein³, Kapil Gururangan³, Qing Hao³, Anuradha Singh³, Jacqueline Becker⁴, Bradley Delman¹, and Priti Balchandani^1,2
1Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States, ²BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States, ³Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States, ⁴General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Since late 2019, COVID-19 has emerged as a global pandemic that has infected 200 million and killed 5 million. A significant proportion of COVID-19 patients continue to have persistent neurological sequelae after recovery, which are not well understood. In this study, we report our preliminary neuroradiological findings from ultrahigh field MRI at 7T in patients with post-COVID neurological symptoms. We show that numerous heterogeneous abnormalities are present in 7T MR brain images. We expect that these findings may pave the way to explain neurological symptoms in post-COVID patients. 

Peiying Liu¹, Thomas Ernst¹, Huajun Liang¹, Dengrong Jiang², Eric Cunningham¹, Zixuan Lin², Meghann C. Ryan^1,3, Hanzhang Lu², Eleanor Wilson⁴, Andrea Levine⁴, and Linda Chang^1
1Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, United States, ²Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States, ³Program in Neuroscience, University of Maryland School of Medicine, Baltimore, MD, United States, ⁴Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States

Post-COVID Syndrome (PCS) is highly prevalent amongst COVID-19 survivors. Neuropsychiatric symptoms are often reported in patients with PCS, suggesting brain involvement in the early stages of COVID-19. One potential etiology is the cerebral microcirculation dysfunction due to SARS-CoV-2 infection, which may affect oxygen delivery and consumption in the brain. In the present study, we investigated the changes in cerebral venous oxygenation, which reflects the balance between oxygen supply and consumption, in convalescent COVID-19 participants with PCS. Our results showed that participants with PCS had altered venous oxygenation in their brain, which was also associated with slower locomotion.

Harkiran K Kooner^1,2, Marrissa J McIntosh^1,2, Maksym Sharma^1,2, Gaurav V Singh³, Neha Nasir³, Emily Blake³, Inderdeep Dhaliwal⁴, Michael Nicholson⁴, Miranda Kirby³, and Grace Parraga^1,2,4
1Robarts Research Institute, London, ON, Canada, ²Department of Medical Biophysics, Western University, London, ON, Canada, ³Department of Physics, Ryerson University, Toronto, ON, Canada, ⁴Division of Respirology, Department of Medicine, Western University, London, ON, Canada

Post-acute COVID-19 syndrome (PACS) is an umbrella term for the long-term symptoms and poor quality-of-life that follow acute SARS-CoV-2 viral-infection in up to 7/10 COVID-19 survivors. The mechanistic understanding of PACS remains poorly understood, which stymies treatment decision-making. In a PACS pilot study, we evaluated hyperpolarized ¹²⁹Xe MRI ventilation defect percent and texture features to measure potential longitudinal changes. There were no significant differences in ¹²⁹Xe MRI ventilation texture measurements six-months and 12-months after a baseline visit (12 weeks post-infection). PACS participants exhibited abnormal second-order ¹²⁹Xe MRI ventilation textures and patchy ventilation, relative to healthy controls, 6-12 months post-infection.

Aisling Fothergill^1,2,3, Christoph Birkl^1,4, Christian Kames^1,2, Alexander Weber¹, and Alexander Rauscher^1,2,5
1UBC MRI Research Centre, University of British Columbia, Vancouver, BC, Canada, ²Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada, ³Geoffrey Jefferson Brain Research Centre, Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom, ⁴Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria, ⁵Department of Pediatrics, Division of Neurology, University of British Columbia, Vancouver, BC, Canada

Given the increased use of facemasks in everyday life, the impacts of these masks on cerebral blood flow (CBF) and oxygenation needs to be investigated. This study used pseudo-continuous arterial spin labeling (pCASL) and quantitative susceptibility mapping (QSM) to determine changes to grey matter CBF and oxygenation respectively. This was done by comparing facemask and no facemask scans for both 3-ply and KN95 masks. The average percent change between the facemask and no facemask oxygenation/susceptibility were insignificant for both mask types, and only the 3-ply facemask showed a statistically significant increase of 5.5% in CBF when wearing the facemask.

Simon Lévy¹, Rafael Heiss¹, Robert Grimm², David Grodzki², Andreas Voskrebenzev^3,4, Jens Vogel-Claussen^3,4, Florian Fuchs⁵, Richard Strauss⁵, Susanne Achenbach⁶, Daniel Klett⁵, Jonas Schmid⁵, Andreas E. Kremer^5,7, Michael Uder¹, Armin M. Nagel¹, and Sebastian Bickelhaupt^1
1Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany, ²MR Application Predevelopment, Siemens Healthcare, Erlangen, Germany, ³Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany, ⁴Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany, ⁵Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany, ⁶Department of Transfusion Medicine and Haemostaseology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany, ⁷Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland

Free-breathing lung images were acquired at 0.55T in 73 Covid-19 patients, on average 5.4 months after the symptoms onset. Perfusion, fractional ventilation and Flow-Volume Loop correlation (FVLc) maps were extracted with the Phase-Resolved Functional Lung analysis technique, and percentages of defect areas were calculated. The most relevant predictors of the presence of persistent symptoms were the areas with concurrent perfusion and FVLc defects, and the areas without defects. Patients could be classified as symptomatic or asymptomatic with an accuracy of 71% when fitting a regression model with these predictors on the entire dataset and their combined score was significantly different.

Alexander M Matheson¹, Harkiran K Kooner¹, Elianna Bier², Junlan Lu², Bastiaan Driehuys², Miranda Kirby³, Giles Santyr^4,5, Mitchell S Albert⁶, Yurii Shepelytskyi⁶, Vira Grynko⁶, Sarah Svenningsen^7,8, Alexei Ouriadov⁹, Inderdeep Dhaliwal¹⁰, J Michael Nicholson¹⁰, and Grace Parraga^1,10
1Department of Medical Biophysics, Robarts Research Institute, Western University, London, ON, Canada, ²Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, United States, ³Department of Physics, Ryerson University, Toronto, ON, Canada, ⁴Hospital for Sick Children, Toronto, ON, Canada, ⁵Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada, ⁶Thunder Bay Regional Health Research Institute, Lakehead University, Thunder Bay, ON, Canada, ⁷Division of Respirology, Department of Medicine, McMaster University, Hamilton, ON, Canada, ⁸St. Joseph's Healthcare, Hamilton, ON, Canada, ⁹Department of Physics and Astronomy, Western University, London, ON, Canada, ¹⁰Division of Respirology, Department of Medicine, Western University, London, ON, Canada

Post-acute COVID19 syndrome (PACS) is an umbrella term for a syndrome of symptoms persisting at least 12 weeks post COVID19 infection. Preliminary studies in PACS patients post-hospitalization revealed abnormally low ¹²⁹Xe RBC-to-barrier ratios, but the clinical relevance of this is not well-understood. We acquired ¹²⁹Xe gas-transfer MRI, spirometry, diffusing-capacity-of-the-lung for carbon-monoxide (DL_CO) and same-day CT in 39 participants including 30 PACS and 9 never-COVID19 controls. The ¹²⁹Xe MRI RBC-to-barrier ratio was significantly related to DL_CO and significantly lower in both never-hospitalized and ever-hospitalized PACS patients compared to never-COVID19 controls.

David Mummy¹, Elianna Bier², Junlan Lu³, Suphachart Leewiwatwong², Aryil Bechtel⁴, Isabelle Dummer⁵, Sakib Kabir¹, Jennifer Korzekwinski¹, Katherine Williford ⁶, Shelby Martindale⁶, Coral Giovacchini⁶, David Shaz⁶, Joseph Mammarappallil¹, Fawaz Alenezi⁶, Raymond Kim⁶, Bastiaan Driehuys¹, and Loretta Que^6
1Radiology, Duke University, Durham, NC, United States, ²Biomedical Engineering, Duke University, Durham, NC, United States, ³Medical Physics, Duke University, Durham, NC, United States, ⁴Physics, Duke University, Durham, NC, United States, ⁵Bioengineering, McGill University, Montreal, QC, Canada, ⁶Medicine, Duke University, Durham, NC, United States

Many patients who recover from COVID-19 have symptoms that persist long after the acute phase of the disease has subsided, including fatigue and dyspnea on exertion. There is an unmet need for understanding the diverse cardiac and pulmonary causes of these symptoms and to monitor patients longitudinally. We imaged N=6 subjects with long-haul COVID using both cardiac MRI and hyperpolarized ¹²⁹Xe MRI and spectroscopy. While cardiac imaging did not reveal structural or functional abnormalities, we observed a wide variety of findings on ¹²⁹Xe MRI, with subjects who had been hospitalized exhibiting the most pronounced gas exchange impairment.  

Mijke Buitinga^1,2, Julian Mevenkamp¹, Florian Haans¹, Kim Brouwers¹, Patrick Schrauwen², Lucas Lindeboom^1,2, Joachim E Wildberger¹, and Vera B Schrauwen-Hinderling^1,2
1Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands, ²Department of Nutrition & Movement Sciences, University of Maastricht, Maastricht, Netherlands

We have developed a novel 3T ¹H-MRS sequence to detect acetylcarnitine. Acetylcarnitine has been investigated by ¹H-MRS in the muscle and is thought to play an important role in maintaining metabolic flexibility and insulin sensitivity. As these are hallmarks of metabolic disease, techniques to study acetylcarnitine levels non-invasively are of great interest. The advantage of our approach is the absence of a subtraction scheme and high signal intensity, while both water and lipid resonances are sufficiently suppressed to uncover the acetylcarnitine resonance. This makes our sequence suitable also for detection in tissues susceptible to respiratory motion, such as the liver.