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Vadim Malis¹, Yoshimori Kassai², Won Bae^1,3, Diana Vucevic¹, Yoshiharu Ohno⁴, and Mitsue Miyazaki^1
1Radiology, UC San Diego, San Diego, CA, United States, ²Canon Medical, Ōtawara-shi, Japan, ³VA San Diego Healthcare System, San Diego, CA, United States, ⁴Fujita Health University, Toyoake, Japan

Keywords: Pulse Sequence Design, Lung, UTE, Ultra-Short TE

δUTE sequence collects multiple closely spaced short TE (<2ms) echoes resulting in a more accurate T₂^* mapping of anatomies with short T₂ time. Application to lungs reveals inhomogeneities in T₂^* maps in post-COVID-19 adults.

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Lea Azour¹, Artem Mikheev¹, Henry Rusinek¹, Mahesh Bharath Keerthivasan², Mary Bruno¹, William Moore¹, and Hersh Chandarana^1
1Radiology, NYU Langone Health, New York, NY, United States, ²Siemens Medical Solutions, New York, NY, United States

Keywords: Lung, COVID-19

Dynamic high temporal resolution free-breathing MRI allows for quantification of respiratory duration, depth and rate—parameters separate from those provided by pulmonary function tests. Post-acute Covid patients with persisting cardiopulmonary symptoms demonstrated larger tidal area, longer duration of inspiration, and larger variability in respirations.

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Christopher Ellis Keen¹, Justin Grenier¹, Peter Šereš¹, Robert Stobbe¹, James White², Christian Beaulieu¹, Ian Paterson³, and Richard Thompson^1
1Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada, ²Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada, ³Division of Cardiology, University of Alberta, Edmonton, AB, Canada

Keywords: Lung, COVID-19

The long term effects of COVID-19, including those affecting the lung, represent a new global health burden. Lung water density (LWD) MRI is an emerging quantitative technique that can be used to measure relative LWD (rLWD) in 3D. 187 patients were imaged 5 months after COVID-19 recovery using LWD MRI and were compared to 91 healthy controls. The COVID-recovered group displayed significantly higher mean rLWD values as compared to healthy controls. Additionally, local and global patterns of abnormally increased and decreased rLWD were observed in the COVID-recovered group.

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Shams Rashid^1,2, Oleksandr Khegai¹, Nathalie Jette³, Puneet Belani¹, Puneet Pawha¹, Sera Saju¹, Ameen Al Qadi¹, 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

Keywords: Infectious disease, COVID-19, Ultrahigh Field, hippocampal subfields, amygdala subnuclei

We present preliminary findings of neuroradiological analysis and FreeSurfer-based cortical segmentation analysis which show changes in deep gray matter structures from ultrahigh field MR neuroimaging at 7T in patients with post-COVID neurological symptoms. 8 hippocampal subfields and 4 amygdala subnuclei had significantly increased volume in a cohort of 12 COVID-19 patients with post-COVID neurological symptoms compared to matched healthy controls. These changes may indicate neuroinflammation of the hippocampus and amygdala in COVID-19, which may be related to the neurological symptoms of memory impairment, “brain fog” and anxiety in our COVID patient cohort.

 

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Breanna Nelson^1,2, Nishtha Parag¹, Lea Farah¹, Portia Kuivi¹, Alysha Alimohamed¹, Harneet Bariana¹, Bella Way¹, Catie Song¹, Ava Grier¹, Chiara DeMarni¹, Jacob Stubbs^1,2, Megan Harper¹, Wayne Su¹, Johnson Chen³, Jessamyn McKenzie¹, Vesna Sossi¹, Mypinder Sekhon³, Donna Lang^1,2, Jonathan Stoessl^1,3, Cheryl Wellington¹, Noah Silverberg^1,3, and William Panenka^1,2
1University of British Columbia, Vancouver, BC, Canada, ²BC Children's Hospital Research Institute, Vancouver, BC, Canada, ³Vancouver Coastal Health, Vancouver, BC, Canada

Keywords: White Matter, COVID-19

Previous research suggests that COVID-19 infection may be associated with brain changes that are similar to a decade of aging.¹ It is unknown whether symptom duration influences brain structure. We compared participants with COVID-19 symptoms for more than 2 months (long-COVID) (n=43) to participants who recovered within 2 months (normal recovery) (n=56). We assessed white matter with diffusion tensor imaging, regional brain volumes using Freesurfer, and cognition using the NIH Toolbox. Although the effect of age on MRI indices and cognition was readily detectable, we found no differences between long-COVID and normal recovery on brain structure or cognitive performance.

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Andrew C. Lancaster¹, Yoko Kato², Chia-Ying Liu³, Yoshimori Kassai³, Jaclyn Sesso², Joao A. C. Lima^2,4, and Bharath Ambale-Venkatesh^4
1School of Medicine, Johns Hopkins University, Baltimore, MD, United States, ²Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States, ³Canon Medical Systems Corporation, Otawara, Japan, ⁴Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States

Keywords: Vessels, COVID-19, Perfusion

Pulmonary perfusion analysis of cardiac magnetic resonance imaging in patients with previous COVID-19 may help phenotype patients with advanced cardiopulmonary disease. Lung perfusion analysis was performed and results were correlated with clinical data in patients who were treated for COVID-19 at Johns Hopkins institutions. Older age and hospitalization for COVID-19 were found to be related to worse pulmonary perfusion, as measured by the perfusion parameter 50% max intensity, suggesting that one long-term sequela of severe COVID-19 that requires hospitalization, particularly in older patients, is a global bilateral decrease in the speed at which the lungs are perfused.

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El-Sayed H. Ibrahim¹, Jason Rubenstein¹, Antonio Sosa¹, Kevin Koch¹, Jadranka Stojanovska², and Ivor Benjamin^1
1Medical College of Wisconsin, Milwaukee, WI, United States, ²New York University, New York, NY, United States

Keywords: Myocardium, COVID-19

Among COVID-19 induced cardiac complications, myocarditis has clinical significance because it can result in permanent myocardial damage which leads to poor outcome. In this study, we studied 65 consecutive COVID-19 patients who underwent cardiac MRI post COVID-19 due to concerns of post-COVID myocarditis or other cardiomyopathies, where MRI was used to identify suspected versus excluded myocarditis based on LGE and T1/ECV/T2 mappings. The results demonstrated the value of MRI systolic strain and diastolic strain rate as sensitive markers for early detection of subclinical cardiac dysfunction and characterizing the heart contractility pattern in high-risk patients with suspected myocarditis versus excluded myocarditis.

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Wen Shi¹, Dengrong Jiang², Hannah Rando³, Shivalika Khanduja³, Zixuan Lin², Kaisha Hazel², George Pottanat², Ebony Jones², Cuimei Xu², Doris D.M. Lin², Sevil Yasar⁴, Sung-Min Cho⁵, and Hanzhang Lu^1,2
1Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States, ²Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States, ³Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States, ⁴Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States, ⁵Department of Neurology, Neurosurgery, Surgery, Anesthesiology, and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States

Keywords: Infectious disease, COVID-19

COVID-19 affects multiple organ systems in the acute phase, however, limited knowledge is known about the long-term impact on the brain following COVID-19 pneumonia, especially for those severe COVID-19 ICU survivors. Here, we used a water-extraction-with-phase-contrast-arterial-spin-tagging (WEPCAST) MRI which can non-invasively measure BBB permeability to water. The results showed significantly higher permeability-surface-area product (PS) in COVID-19 ICU survivors, which provided preliminary evidence that there was a BBB breakdown in COVID-19 ICU survivors at 4 months after initial infection.

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Pablo García-Polo^1,2, Angel Torrado-Carvajal², Mar Jiménez³, Juan Bachiller³, Vicente Martínez³, Adolfo Toledano⁴, Cristina Gómez², and Susana Borromeo^2
1GE Healthcare, Madrid, Spain, ²University Rey Juan Carlos, Móstoles, Spain, ³Hospital Quironsalud Madrid, Pozuelo de Alarcón, Spain, ⁴Hospital Universitario Fundación Alcorcón, Alcorcón, Spain

Keywords: Infectious disease, COVID-19, Anosmia

Olfactory fMRI has provided an objective assessment of olfactory function in normal brain and pathological subjects. Optimizing the fMRI acquisition is of paramount importance when studying olfactory areas due to high B0 inhomogeneities and thin cortical areas involved. Fully synchronizing the acquisition to the odorants delivery with patient respiration increases the effectiveness of the experiment. Using this technique in COVID-19 patients with anosmia could determine the correct rehabilitation therapy for these subjects and new treatment pathways.

Yufan Qian¹, Weibo Chen², Yan Zhou¹, Lei Zhao³, and Lian-Ming Wu^1
1Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China, ²Philips Healthcare, Shanghai, China, ³Beijing Anzhen Hospital, Capital Medical University, Shanghai, China

Keywords: Heart, COVID-19, review

The purpose is to find the cardiac involvement features of COVID-19 using cardiac MRI, and set forth the relationship of these cardiac features with their clinical presentation. We analyzed the results under the separate cardiovascular magnetic resonance sequences combining different stages, as well as consider the unique conditions when cardiovascular signs and symptoms are present.

Tingting Pan^1,2, Yaping Wu², Xuan Yu², Yan Bai², and Meiyun Wang^1,2
1Henan academy of sciences, Zhengzhou, China, ²Department of Medical Imaging, Henan Provincial People's Hospital & the People's Hospital of Zhengzhou University, Zhengzhou, China

Keywords: Brain Connectivity, COVID-19

The neural mechanisms underlying the neuropsychiatric disorders suffered by Long-Covid-19 patients remain unknown. Non-invasive [18F]-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) brain imaging is an effective way to study this issue. In the present study, based on 18F-FDG PET brain imaging and analysis of the brain metabolic network, we found significant reductions in metabolic levels in the frontal, temporal, and parietal lobes in patients with Long-Covid-19. A significant reduction in metabolic connectivity between temporal and frontal networks in patients with Long-Covid-19 may be the underlying neural mechanism underlying cognitive impairment.

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Dengrong Jiang¹, Hannah Rando², Shivalika Khanduja², Jie Song³, Kaisha Hazel¹, George Pottanat¹, Ebony Jones¹, Cuimei Xu¹, Wen Shi⁴, Zhiyi Hu⁴, Doris Lin¹, Sevil Yasar⁵, Sung-Min Cho², and Hanzhang Lu^1
1Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States, ²Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States, ³Department of Biomedical Engineering, Johns Hopkins University School of Engineering, Baltimore, MD, United States, ⁴Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States, ⁵Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States

Keywords: Infectious disease, COVID-19

Compared to patients with mild COVID-19 disease, critically ill patients requiring intensive-care-unit (ICU) admission are at higher risk of developing post-acute COVID-19 syndrome (PCS). The mechanisms underlying PCS are under investigation and may involve neurovascular damage, which can disrupt oxygen delivery and utilization in the brain. Cerebral oxygen-extraction-fraction (OEF) is an important parameter for the brain’s oxygen utilization. In this work, we evaluated the post-acute changes of regional OEF in COVID-19 ICU-survivors, and found that ICU-survivors had significantly increased OEF in the frontal lobe compared to controls. This suggests that regional OEF may provide a sensitive biomarker in studying PCS.

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Keegan Staab¹, Jonathan Percy², Andrew D. Hahn³, Stanley J. Kruger³, Alejandro P. Comellas⁴, Jessica C. Sieren³, Eric A. Hoffman³, and Sean B. Fain^3
1Biomedical Engineering, University of Iowa, Iowa City, IA, United States, ²Physics, University of Iowa, Iowa City, IA, United States, ³Radiology, University of Iowa, Iowa City, IA, United States, ⁴Internal Medicine, University of Iowa, Iowa City, IA, United States

Keywords: Lung, COVID-19

Repeatability visits with hyperpolarized 129Xe MRI of ventilation and gas exchange measures were acquired at baseline and 3-6 weeks after baseline in patients with persistent dyspnea, fatigue, and neurocognitive symptoms (“Long” COVID). Findings did not support the same repeatability of measures found in a previous study of IPF, suggesting instability of pulmonary pathophysiology is a characteristic of Long COVID.

Yu Shen^1,2, Xianchang Zhang³, Yaping Wu^1,2, Yan Bai^1,2, Wei Wei^1,2, Lijuan Chen^1,2, and Meiyun Wang^1,2
1Department of Medical Imaging, Henan Provincial People’s Hospital & Zhengzhou University People’s Hospital, Zhengzhou, China, ²Henan Key Laboratory of Neurological Imaging, Zhengzhou, China, ³MR Collaboration, Siemens Healthcare Ltd, Beijing, China

Keywords: Neuroinflammation, COVID-19, perfusion，follow up

COVID-19 may affect the brain of patients, ranging in severity from confusion to life-threatening strokes. This study investigated the potential cerebral perfusion change in COVID-19- infected patients using pseudo-continuous arterial spin labeling (pCASL) sequence by follow up after patients recovered for 4, 12 and 18 months. It’s found that both cerebral blood flow (CBF) and bolus arrival time (BAT) values derived from pCASL demonstrated an increasing tendency over time in several brain areas in COVID-19 survivors after whole brain analysis. Our findings indicated that COVID-19 survivors may experience compensatory brain function recovery and this recovery process would be slow.

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Adrienne E Campbell-Washburn¹, Shreya M Kanth², Julio A Huapaya², Matthew Thurston¹, Christine Mancini¹, Kendall J O'Brien¹, Amanda Potersnak¹, Haiyan Wang¹, David Regenold³, Scott Baute¹, Marcus Y Chen¹, Ahsan Javed¹, and Anthony F Suffredini^2
1National Heart, Lung, and Blood Insitute, National Institutes of Health, Bethesda, MD, United States, ²Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, United States, ³National Institute of Allergy and Infection Diseases, National Institutes of Health, Bethesda, MD, United States

Keywords: Lung, COVID-19

COVID-19 infection has been reported to cause pulmonary perfusion defects associated with pulmonary embolism and infiltrates. We used quantitative dynamic contrast enhanced 0.55T MRI, with pharmacokinetic modelling, to monitor lung perfusion longitudinally in 139 patients with COVID-19. We observed significant associations between disease severity and perfusion during the convalescent phase (91-365d post symptom onset); and between abnormal perfusion during the acute phase (0-40d) and low pulmonary function later during recovery. Quantitative pulmonary perfusion measured by MRI may be a useful metric to study patients with COVID-19 infection, and early results suggest long-term perfusion abnormalities in patients with severe disease.

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Sharyfah Alasiri^1,2, Elisa Zamboni^2,3, Isaac Watson^2,4, Heather Owston⁵, Heidi Baseler^3,6, Dennis McGonagle⁷, and Aneurin Kennerley^2,8
1Biomedical Sciences, University of York, York, United Kingdom, ²York Neuroimaging Centre, University of York, York, United Kingdom, ³Psychology, University of York, York, United Kingdom, ⁴School of Physics, Engineering, and Technology, University of York, York, United Kingdom, ⁵Medical and Biological Engineering, University of Leeds, Leeds, United Kingdom, ⁶Hull York Medical School, University of York, York, United Kingdom, ⁷School of Medicine, University of Leeds, Leeds, United Kingdom, ⁸Institute of Sport, Manchester Metropolitan University, Manchester, United Kingdom

Keywords: Blood vessels, COVID-19, cerebrovascular reactivity

Strategies to help sufferers from Long COVID (LC) mostly focus on symptoms management.  There is an urgent need for understanding whether and how the cerebrovascular system is implicated in emergent symptoms. Here we use advanced cerebral blood volume (CBV)-based imaging techniques to appropriately quantify changes in vascular reactivity in patients affected by LC compared to healthy volunteers. A slower vasodilation mechanisms, leading to inappropriate oxygen supply during neuronal function, could be used as biomarker and help clinical diagnosis.

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Harkiran K Kooner^1,2, Maksym S Sharma^1,2, Marrissa J McIntosh^1,2, Inderdeep Dhaliwal³, J Michael Nicholson³, and Grace Parraga^1,2,3
1Department of Medical Biophysics, Western University, London, ON, Canada, ²Robarts Research Institute, London, ON, Canada, ³Division of Respirology, Department of Medicine, Western University, London, ON, Canada

Keywords: Hyperpolarized MR (Gas), Lung

Post-acute COVID-19 syndrome (PACS) is an umbrella term for  symptoms and poor quality-of-life, four weeks+ after acute COVID-19 infection, reported in up to 30% of COVID-19 survivors. The longitudinal trajectory of PACS remains largely unknown. ¹²⁹Xe MRI ventilation defects did not help to explain longitudinal quality-of-life outcomes in PACS and thus, texture analysis was used to evaluate potential ventilation features that could explain quality-of-life. We identified the ¹²⁹Xe MRI ventilation texture features that predicted clinically relevant quality-of-life improvements 15-months post-infection, outperforming clinical models. These findings also suggest that ventilation texture features capture underlying pathophysiology not reflected by ventilation-defect-percent.   

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Paul John Clifford Hughes¹, Laura Saunders¹, Louise V Wain^2,3, Christopher E Brightling², Stefan Neubauer^4,5, Betty Raman⁴, C-MORE/PHOSP-COVID Collaborative Group⁶, and Jim Wild^1
1POLARIS, University of Sheffield MRI Unit, IICD, The University of Sheffield, Sheffield, United Kingdom, ²Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, United Kingdom, ³Department of Health Sciences, University of Leicester, Leicester, United Kingdom, ⁴Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom, ⁵Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom, ⁶Full group details can be found in Appendix 1 of, https://doi.org/10.1016/S2213-2600(21)00383-0, London, United Kingdom

Keywords: Lung, Lung

Disruption to pulmonary perfusion is seen in several diseases, with most work focusing on the first-pass to calculate metrics of pulmonary blood volume and flow and mean transit time. The additional information from the leakage-phase acquisition has shown utility in multiple organs but it is less commonly used in the lung. This work aimed to assess the differences between fitting data with and without the first-pass bolus to estimate the volume transfer constant and fractions of blood in the extravascular-extracellular space and plasma in a multicentre setting.

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Nick Teller¹, Jordan A. Chad^1,2, Alexander Wong³, Hayden Gunraj³, Xiang Ji⁴, Bradley J. MacIntosh^2,4, Asaf Gilboa^1,5, Eugenie Roudaia¹, Allison B. Sekuler^1,5, Benjamin Lam⁴, Chris Heyn⁴, Sandra E. Black⁴, Simon J. Graham^2,4, and J. Jean Chen^1,2,6
1Rotman Research Institute, North York, ON, Canada, ²Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada, ³Department of System Design Engineering, University of Waterloo, Waterloo, ON, Canada, ⁴Sunnybrook Research Institute, Sunnybrook Health Science Centre, Toronto, ON, Canada, ⁵Department of Psychology, University of Toronto, Toronto, ON, Canada, ⁶Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada

Keywords: Data Analysis, Diffusion/other diffusion imaging techniques, Correlated diffusion imaging, single-shell diffusion MRI.

This study examines microstructural white-matter differences between self-isolated COVID-19 patients and controls using correlated diffusion (CDI) and diffusion-tensor imaging (DTI) based on single-shell acquisitions. Correlated diffusion imaging reveals microstructural differences between patients and controls in frontal, olfactory, and cerebellar regions previously unseen with diffusion-tensor imaging. Our results suggest CDI as a feasible single-shell imaging technique that is sensitive to distinct impacts in various brain regions.

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Li Jiang¹ and Yulin Ge^1
1Radiology, NYU Grossman School of Medicine, New York, NY, United States

Keywords: Neuroinflammation, Toxicity, Encephalopathy, COVID, renal, toxic

COVID-19 continues to be a threat to global public health. A large number of studies have reported various neurological symptoms in COVID-19 patients even after the respiratory symptoms have resolved. In severe cases, the neurological complications induced by SARS-CoV-2 can lead to extensive neuroimaging abnormality. Additionally, previous studies have shown that, among COVID-19 patients who went through dialysis, the short-term mortality rate is high. In this study,  we reported three cases of deceased patients who had severe encephalopathy while going through dialysis, to better understand their fatal disease course and associated brain MRI and clinical symptoms complicated by COVID-19.