key: cord-0794640-rxdhw7o3
authors: Purcell, Yvonne; Lecler, Augustin; Saragoussi, Edouard; Poiron, Emilie; Poillon, Guillaume; Savatovsky, Julien
title: Neurological Involvement of COVID-19 Patients: Making the Most of MRI
date: 2020-06-09
journal: Radiology
DOI: 10.1148/radiol.2020202466
sha: bd4218e5a0aaa46a1f5e3ac8ed2557ed9617f6e7
doc_id: 794640
cord_uid: rxdhw7o3

nan

We read with interest the recent article by Mahammedi et al 1 In our practice, leptomeningeal enhancement appears to be a common feature in COVID-19 patients with neurological symptoms. We noticed that such abnormalities are usually not visible using CT alone, noncontrast brain MRI or even post-gadolinium 3D T1WI. Conversely, This copy is for personal use only. To order printed copies, contact reprints@rsna.org I n P r e s s adding a post-contrast 3D FLAIR sequence for suspected cases of 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 4-fold more sensitive than T1-weighted imaging for the detection of low concentrations of contrast in CSF. 3 This superiority has been demonstrated in diseases such as meningeal carcinomatosis 4 and Susac's syndrome 5 .

Furthermore, performing FLAIR in 3D allows good suppression of CSF in normal areas, increasing the contrast with potential leptomeningeal abnormalities.

We hypothesize that the low rate of leptomeningeal abnormalities in the study by Mahammedi et al. may be due to 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 post-contrast 3D FLAIR sequence to brain MRI protocols for the investigation of COVID-19 patients presenting with any neurological symptom, including confusion and headaches.

Imaging in Neurological Disease of Hospitalized COVID-19 Patients: An Italian Multicenter Retrospective Observational Study

Online ahead of print

Visualization of Intravenously Administered Contrast Material in the CSF on Fluid-Attenuated Inversion-Recovery MR Images: An

FLAIR MR Imaging for Diagnosing Intracranial Meningeal Carcinomatosis

Diagnosis and Prediction of Relapses in Susac syndrome: A New Use for MR Postcontrast FLAIR Leptomeningeal Enhancement