Evaluation of Cerebrovascular Reactivity and Vessel Wall Imaging in Patients With Prior COVID-19: A Prospective Case-Control MRI Study

• Published in: American journal of roentgenology (1976) Vol. 220; no. 2; pp. 257 - 264
• Main Authors: Callen, Andrew L, Tanabe, Jody, Thaker, Ashesh A, Pollard, Rebecca, Sauer, Brian, Jones, William, Pattee, Jack, Steach, Brandon, Timpone, Vincent M
• Format: Journal Article
• Language: English
• Published: United States 01-02-2023
• Subjects: Acetazolamide; Adult; Brain - diagnostic imaging; Cerebrovascular Circulation - physiology; COVID-19; Critical Illness; Female; Humans; Magnetic Resonance Imaging; Male; Prospective Studies; SARS-CoV-2; COVID-19; SARS-CoV-2; cerebral vasoreactivity; perfusion; arterial wall imaging
• ISSN: 0361-803X; 1546-3141
• DOI: 10.2214/AJR.22.28267

SARS-CoV-2 infection is associated with acute stroke, possibly caused by viral tropism to the vascular endothelium. Whether cerebrovascular endothelial dysfunction and inflammation persist after acute infection is poorly understood.
The purposes of this study were to assess the association between prior SARS-CoV-2 infection and cerebrovascular reactivity (CVR) and vessel wall imaging (VWI) abnormalities and to explore the association between CVR impairment and post-COVID neurologic conditions.
This prospective study included 15 participants with prior SARS-CoV-2 infection (11 women, four men; mean age, 43 years; mean time since infection, 238 days; three with prior critical illness, 12 with prior mild illness; seven with post-COVID neurologic conditions) and 10 control participants who had never had SARS-CoV-2 infection (two women, two men; mean age, 44 years) from July 1, 2021, to February 9, 2022. Participants underwent research MRI that included arterial spin labeling perfusion imaging with acetazolamide stimulus to measure cerebral blood flow (CBF) and calculate CVR. Examinations also included VWI, performed with a contrast-enhanced black-blood 3D T1-weighted sequence. An age- and sex-adjusted linear model was used to assess associations between CVR and prior infection. A
test was used to assess associations between CVR and post-COVID neurologic conditions in participants with previous infection. A difference of proportions test was used to assess associations between VWI abnormalities and infection status.
Mean whole-cortex CBF after acetazolamide administration was greater in participants without previous infection than in participants with previous infection (73.8 ± 13.2 [SD] vs 60.5 ± 15.8 mL/100 gm/min;
= .04). Whole-brain CVR was lower in participants with previous infection than those without previous infection (difference, -8.9 mL/100 g/min;
< .001); significantly lower CVR was also observed in participants with previous infection after exclusion of those with prior critical illness. Among participants with previous infection, CVR was lower in those with than those without post-COVID neurologic conditions, although this difference was not significant (16.9 vs 21.0 mL/100 g/min;
= .22). Six of 15 (40%) participants with previous infection versus 1 of 10 (10%) participants without previous infection had at least one VWI abnormality (
= .18). All VWI abnormalities were consistent with atherosclerosis.
SARS-CoV-2 infection is associated with chronic impairment of CVR. The mechanism is unknown from this study.
Future studies are needed to determine the clinical implications of SARS-CoV-2-associated CVR impairment.