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• W3033329808 abstract "HomeRadiologyVol. 297, No. 1 PreviousNext CommunicationsFree AccessLetters to the EditorNeurologic Involvement of Patients with Coronavirus Disease 2019: Making the Most of MRIYvonne Purcell , Augustin Lecler, Edouard Saragoussi, Emilie Poiron, Guillaume Poillon, Julien SavatovskyYvonne Purcell , Augustin Lecler, Edouard Saragoussi, Emilie Poiron, Guillaume Poillon, Julien SavatovskyAuthor AffiliationsDepartment of Radiology, Fondation Ophtalmologique Adolphe de Rothschild, 29 rue Manin, Paris 75019, Francee-mail: [email protected]Yvonne Purcell Augustin LeclerEdouard SaragoussiEmilie PoironGuillaume PoillonJulien SavatovskyPublished Online:Jun 9 2020https://doi.org/10.1148/radiol.2020202466MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Editor:We read with interest the recent article by Dr Mahammedi and colleagues (1) describing a spectrum of neuroimaging features of patients positive for coronavirus disease 2019 (COVID-19) at CT and MRI. There was a pressing need for a useful study such as this that reported on the largest patient population to date with neurologic symptoms because of COVID-19. None of their cases showed abnormal parenchymal or leptomeningeal enhancement, although half (10 of 20) of the patients who underwent brain MRI also underwent postcontrast agent–enhanced imaging.However, Helms et al (2) reported leptomeningeal enhancement on MRI in 62% of their patients. Critically, Helms et al performed both three-dimensional (3D) fluid-attenuated inversion recovery (FLAIR) and 3D T1-weighted sequences after injection of gadolinium chelate. In their supplemental figures (2), foci of abnormal leptomeningeal enhancement were most clearly demonstrated on the contrast-enhanced FLAIR sequence rather than the noncontrast-enhanced FLAIR or T1-weighted postcontrast sequences.In our practice, leptomeningeal enhancement appears to be a common feature in patients with COVID-19 with neurologic symptoms. We noticed that such abnormalities are usually not visible by using CT alone, noncontrast-enhanced brain MRI, or even after gadolinium chelate–enhanced 3D T1-weighted imaging. Conversely, adding a contrast-enhanced 3D FLAIR sequence for patients suspected of having COVID-19 improves the conspicuity of abnormalities in the leptomeningeal compartment.The value of contrast-enhanced FLAIR for the detection of leptomeningeal enhancement is well established and considered up to fourfold more sensitive than T1-weighted imaging in detecting low concentrations of contrast agent in cerebrospinal fluid (3). This superiority has been demonstrated in diseases such as meningeal carcinomatosis (4) and Susac syndrome (5). Furthermore, performing 3D FLAIR allows for good suppression of CSF in healthy areas, increasing the contrast with potential leptomeningeal abnormalities.We hypothesize that the low rate of leptomeningeal abnormalities in the study by Dr Mahammedi and colleagues may be because of the lack of contrast-enhanced FLAIR sequence, which is not the standard of care in many institutions.In conclusion, we advocate the integration of a contrast-enhanced 3D FLAIR sequence to brain MRI protocols for the investigation of COVID-19 patients presenting with any neurologic symptom, including confusion and headaches.Disclosures of Conflicts of Interest: Y.P. disclosed no relevant relationships. A.L. disclosed no relevant relationships. E.S. disclosed no relevant relationships. E.P. disclosed no relevant relationships. G.P. disclosed no relevant relationships. J.S. related to the present article: disclosed no relevant relationships. Activities not related to the present article: disclosed payment for lectures from Biogen, Sanofi, Medtronic, and Philips. Other relationships: disclosed no relevant relationships.References1. Mahammedi A, Saba L, Vagal A, et al. Imaging in Neurological Disease of Hospitalized COVID-19 Patients: An Italian Multicenter Retrospective Observational Study. Radiology 2020. 10.1148/radiol.2020201933. Published online May 21, 2020 https://doi.org/10.1148/radiol.2020201933. Link, Google Scholar2. Helms J, Kremer S, Merdji H, et al. Neurologic Features in Severe SARS-CoV-2 Infection. N Engl J Med 2020;382(23):2268–2270. Crossref, Medline, Google Scholar3. Mamourian AC, Hoopes PJ, Lewis LD. Visualization of intravenously administered contrast material in the CSF on fluid-attenuated inversion-recovery MR images: an in vitro and animal-model investigation. AJNR Am J Neuroradiol 2000;21(1):105–111. Medline, Google Scholar4. Tsuchiya K, Katase S, Yoshino A, Hachiya J. FLAIR MR imaging for diagnosing intracranial meningeal carcinomatosis. AJR Am J Roentgenol 2001;176(6):1585–1588. Crossref, Medline, Google Scholar5. Coulette S, Lecler A, Saragoussi E, et al. Diagnosis and Prediction of Relapses in Susac Syndrome: A New Use for MR Postcontrast FLAIR Leptomeningeal Enhancement. AJNR Am J Neuroradiol 2019;40(7):1184–1190. Crossref, Medline, Google ScholarArticle HistoryPublished online: June 09 2020Published in print: Oct 2020 FiguresReferencesRelatedDetailsCited ByNeuroimaging in patients with COVID-19: a neuroradiology expert group consensusStéphaneKremer, SimonettaGerevini, AnaRamos, FrançoisLersy, TarekYousry, Meike W.Vernooij, NicolettaAnzalone, Hans RolfJäger2022 | European Radiology, Vol. 32, No. 6Neuroimaging Findings of SARS-CoV-2 InfectionA.Aein, S.Khanpara, R.Samant, Y.F.Cai, L.Nunez, S.I.Savitz, J.M.Romero, R.F.Riascos2022 | Neurographics, Vol. 12, No. 3Imaging findings of multisystem inflammatory syndrome in children associated with COVID-19PabloCaro-Domínguez, MaríaNavallas, LuciaRiaza-Martin, MaryamGhadimi Mahani, Carlos F.Ugas Charcape, IsraelValverde, FeliceD’Arco, SeemaToso, Susan ChengShelmerdine, Joostvan Schuppen, AurelioSecinaro, DanielGräfe, MarisolCamacho, OlafNeth, Hyun WooGoo, Christian J.Kellenberger2021 | Pediatric Radiology, Vol. 51, No. 9Recommended Articles Evolution of Volume and Signal Intensity on Fluid-attenuated Inversion Recovery MR Images after Endovascular Stroke TherapyRadiology2016Volume: 280Issue: 1pp. 184-192Diagnostic Accuracy of a Fluid-attenuated Inversion-Recovery Sequence with Fat Suppression for Assessment of Peripatellar Synovitis: Preliminary Results and Comparison with Contrast-enhanced MR ImagingRadiology2016Volume: 283Issue: 3pp. 769-778Brain MRI Findings in Patients in the Intensive Care Unit with COVID-19 InfectionRadiology2020Volume: 297Issue: 1pp. E232-E235Susceptibility-weighted Imaging: Technical Essentials and Clinical Neurologic ApplicationsRadiology2021Volume: 299Issue: 1pp. 3-26Multimodality Review of Amyloid-related Diseases of the Central Nervous SystemRadioGraphics2016Volume: 36Issue: 4pp. 1147-1163See More RSNA Education Exhibits Contrast-enhanced 3D T2-FLAIR Imaging Of The Brain: What Should Radiologists Know?Digital Posters2021Leptomeningeal Enhancement On Postcontrast 3D-flair Imaging In Multiple Sclerosis: A Retrospective Study In A General Hospital.Digital Posters2021Case Based Review of Meningeal DisordersDigital Posters2022 RSNA Case Collection Leptomeningeal CarcinomatosisRSNA Case Collection2020Tuberculous Leptomeningitis with Vasculitic InfarctRSNA Case Collection2021Intracranial TBRSNA Case Collection2022 Vol. 297, No. 1 Metrics Altmetric Score PDF download" @default.
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