NeuroCOVID’s Impact on Standard Radiology Protocols

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In the wake of the SARS-CoV-2 virus, many areas of medical research were put on hold so the community could focus on treatments, vaccines and preventive measures. As the new COVID-19 vaccines begin going public, it’s likely that the general public’s concerns about the long-term impact of the virus on infected patients will wane.

However, it’s possibly more important than ever that we continue studying the impacts of SARS-CoV-2, particularly its enduring effects on the general public and patients who were infected. As members of the radiology community, we have a duty to the general public’s health to be more proactive in evaluating the health and longevity of our patients.

With the lasting impacts of this novel virus currently unknown, it’s difficult for those in the medical field to anticipate what issues may arise in the future. As studies continue showing the lasting effects of COVID-19 on the body, there’s an incredibly important organ that researchers and clinicians shouldn’t overlook: the brain.

What is NeuroCOVID?

It’s shown that COVID-19 typically affects lung tissue, often leading to symptoms such as shortness of breath, coughing, chest pressure, loss of smell, and trouble breathing in many patients. Between lung tissue inflammation, infected alveolus, acute respiratory distress syndrome (ARDS) and more, much of the research into treating COVID-19 understandably focuses heavily on the respiratory and circulatory systems.

What’s often less-considered, however, is the impact SARS-CoV-2 can have on the brain. Over the last several months, MR studies revealed a new post-COVID condition, coined NeuroCOVID. This condition suggests that individuals who survive a serious case of COVID-19 show evidence of brain structure alterations and the development of lesions in brain tissue.

NeuroCOVID is a condition that encompasses the vascular effects of the virus on the human brain. This vascular damage manifests in the form of cerebral microbleeds (CMBs) and hemorrhagic lesions, but damage can also include structural, volumetric alterations to the brain tissue such as temporary swelling or tissue atrophy (shrinkage).

Why should we be concerned?

It is very likely that a significant number of patients with ARDS associated with a COVID-19 diagnosis will present the NeuroCOVID complication. Therefore, diagnosing critical illness-associated cerebral microbleeds (CIAM) by MRI is essential to effective treatment, as is avoiding misdiagnosis such as hemorrhagic encephalitis related to SARS-CoV-2.

In COVID-19 positive individuals, we’re seeing that these CMBs can cause lasting cognitive impairments, in many ways mirroring symptoms of dementia. Americans are surprisingly doctor-averse, so it’s entirely possible that individuals who contracted a mild case decided to “handle it themselves,” skipping a doctor visit or diagnosis entirely. Many other patients wait until their illness is incredibly advanced to seek medical assistance.

Either way, it’s likely that individuals with COVID-19 aren’t prioritizing a brain MRI as part of their diagnosis or treatment plan, but NeuroCOVID studies suggest that they should. In both instances, it’s difficult to quantify the damage to the brain without comparative imagery, and the implications of lasting brain damage brings up an important question.

Will NeuroCOVID patients have lifelong issues with functioning as independent adults due to enduring complications from COVID-19?

Over the next several years, radiology departments will likely find incoming patients with persistent issues due to COVID-19, and we’ll need to establish better ways to help and diagnose them. This starts with providing patients with a higher-caliber brain scan experience.

Why does radiology need to change?

In research involving brain imaging, the ability to categorize scans by age, sex, whether someone’s a smoker, etc. is vital to determining and eliminating biases in conclusions. It’s entirely possible that a globally-spread novel virus could change the general population’s basic brain structures and characteristics by as early as next year.

Given the rapid extent of exposure to COVID-19 and a still-climbing infection rate, the “normal” MR screening protocol should be reviewed. Radiological researchers may need to account for a “COVID bias” when analyzing brain images. In a clinical setting, it could mean that patients who tested positive should receive a different set of MRI protocols for future brain imaging.

In both research and clinics, the way we complete brain scans for patients needs to put greater emphasis on higher-quality imaging to track and manage changes to brain damage and structure.

The Future of NeuroCOVID Radiology

With the potential for changes to the general population’s brain structures, it may be time to reexamine the use of faster, less-detailed MRI protocols. Radiology departments need to provide patients with quality care while balancing necessary budget cuts. This can mean working more efficiently within the limitations they have, or exploring new technology options to ease workflow strain.

When completing general exploratory MRI screenings, many scans use 2-D with “quick and dirty” protocols. These show the brain’s larger structures, but oftentimes aren’t detailed enough to meaningfully track long-term tissue changes, CMB progression, atrophying or swelling in response to infection.

Beyond treating immediate patient issues, radiologists also need to balance a patient’s potential future health changes while creating a positive patient experience. This means providing the highest-quality images as fast as possible, with high-detail protocols run towards the beginning of the scan instead of the end.

By completing higher-detail protocols earlier in a scan, radiologists can ensure they don’t run into time constraints that would prevent the capture of information-rich outputs, even if the protocols take slightly longer. It’s important that completed protocols provide data that’s sensitive enough to detect brain damage, especially issues that are more difficult to detect, through a higher-resolution dataset. Without more detailed scans, organizations may run into higher rates of “inconclusive findings” for patients, leading to unnecessary time spent on repeat scans.

Looking Ahead

Whether through advanced imaging protocols and other MRI technological advances, balancing NeuroCOVID patient care with capacity issues presents an incredible challenge for radiology departments. As the medical community continues working hard to understand the immediate and future impacts of SARS-CoV-2, hospitals, imaging centers and research facilities need to re-examine their current MR protocols and determine their imaging needs moving forward to better serve this new population. We’re hopeful that with the right tools, goals and mindset the medical community will find the answer to what hurdles COVID-19 patients can expect to face in the near to distant future.

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