Brain and Lung Imaging Correlation in Patients with COVID-19: Could the Severity of Lung Disease Reflect the Prevalence of Acute Abnormalities on Neuroimaging? A Global Multicenter Observational Study

Receiver operating characteristic curve showing the sensitivity and specificity of the CT lung severity score as a predictor of acute neuroimaging abnormalities in patients with COVID-19 with neurologic symptoms. The area under the curve corresponds to the accuracy. ROC indicates receiver operating characteristic.

Acute leukoencephalopathy. A 48-year-old man without a history of seizures presented with convulsions and altered mental status. Extensive and confluent symmetric deep and subcortical white matter FLAIR hyperintensities in the bilateral centra semiovale (A) and periventricular frontal and parietal regions (B) with associated mild restricted diffusion on DWI/ADC images, most prominent in the centra semiovale (C and D) and peritrigonal regions (E and F). No associated enhancement or microbleed was seen on the T1 postcontrast and SWI (not shown). Coronal MPR and axial noncontrast images in lung windows demonstrate mixed ground-glass and consolidative opacities in all lobes with a lower lung and peripheral predominance (G–J). The CT lung severity score was 16 (right upper lobe, right lower lobe, left upper lobe, left lower lobe, 25%–49% and right middle lobe 50%–75%). The chest CT scan was obtained 8 days after the initial onset of respiratory symptoms.

Acute infarct, multifocal microbleeds, and subcortical white matter FLAIR hyperintensity. A 65-year-old man presented with altered mental status and ischemic stroke. Available prior brain MR imaging findings from 1 month ago were normal. A and B, New punctate microbleeds on gradient-echo sequences in the right superior parietal lobule, left inferior parietal lobule, and right cerebellum. Note a small area of restricted diffusion in the anterior left cerebellum on DWI/ADC images (C–D) with FLAIR hyperintensities (E), consistent with acute infarct. New punctate deep and subcortical white matter FLAIR hyperintensities without associated hemorrhage or restricted diffusion in the left-greater-than-right frontal (F), parietal (G), and occipital lobes (H). Axial chest CT images show right apical GGOs and biapical paraseptal emphysema (I). Bilateral GGOs are right greater than left (J). Patchy consolidations in the apical segment of the lower lobe of the right lung (K). Extensive consolidation with an air bronchogram in the right lower lobe (L). The CT lung severity score was 14. The chest CT scan was obtained 10 days after initial onset of respiratory symptoms.

PRES. A 25-year-old woman presented with altered mental status and ischemic stroke. A and B, Extensive cortical and subcortical areas of T2/FLAIR hyperintensity in the right frontal and bilateral parietal lobes. Associated patchy and confluent leptomeningeal enhancement is seen only on FLAIR postcontrast image (C) but not on T1 postcontrast image (D). Note no restriction diffusion or hemosiderin on DWI and gradient-echo sequences (E and F). Axial chest CT scans show new extensive bilateral patchy consolidations in the upper lobes with bilateral right-more-than-left pleural effusions (G and H). The CT lung severity score was 12. The chest CT scan was obtained 7 days after the initial onset of respiratory symptoms.

Multifocal microbleeds and deep white matter FLAIR hyperintensities. A 63-year-old man presented with altered mental status. Available prior brain MR imaging findings from 3 months ago were normal. Note confluent periventricular white matter T2/FLAIR hyperintensities, most prominent in the peritrigonal regions (A and B), with new punctate microbleeds on gradient-echo sequences in the right frontoparietal regions (C) and left frontal lobe (D). No associated enhancement is seen on the T1 postcontrast image. Axial chest CT images in lung windows show bilateral, peripheral, predominant ground-glass opacities and dependent consolidations in the upper and lower lobes (F–I). Note air bronchograms in both lower lobes (H and I). The CT lung severity score was 18. The chest CT scan was obtained 11 days after the initial onset of respiratory symptoms.