On the merits and potential of advanced neuroimaging techniques in COVID-19: A scoping review

Graphical abstract

Highlights

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  Advanced neuroimaging complements structural clinical imaging findings in COVID-19.

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  Advanced neuroimaging findings reflect hypoxic, vascular, and inflammatory damage.

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  In vivo advanced neuroimaging findings are supported by postmortem histology.

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  Cerebral abnormalities are likely attributed to indirect viral infection.

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  Understanding COVID-19 neuropathology demands multiparametric imaging protocols.

Abstract

Many Coronavirus Disease 2019 (COVID-19) patients are suffering from long-term neuropsychological sequelae. These patients may benefit from a better understanding of the underlying neuropathophysiological mechanisms and identification of potential biomarkers and treatment targets. Structural clinical neuroimaging techniques have limited ability to visualize subtle cerebral abnormalities and to investigate brain function. This scoping review assesses the merits and potential of advanced neuroimaging techniques in COVID-19 using literature including advanced neuroimaging or postmortem analyses in adult COVID-19 patients published from the start of the pandemic until December 2023. Findings were summarized according to distinct categories of reported cerebral abnormalities revealed by different imaging techniques. Although no unified COVID-19-specific pattern could be subtracted, a broad range of cerebral abnormalities were revealed by advanced neuroimaging (likely attributable to hypoxic, vascular, and inflammatory pathology), even in absence of structural clinical imaging findings. These abnormalities are validated by postmortem examinations. This scoping review emphasizes the added value of advanced neuroimaging compared to structural clinical imaging and highlights implications for brain functioning and long-term consequences in COVID-19.