Although neurological symptoms are being observed in a high number of COVID-19 patients, a prospective study aimed at scanning recovered COVID-19 patients with advanced multi-modal neuroimaging methods has yet to be performed. There is much to be learned about the persisting effects of the SARS-CoV-2 virus on the central nervous system, and high-resolution magnetic resonance imaging (MRI) is the ideal non-invasive tool to reveal these effects as well as mechanisms of infection. In this work, we will leverage the high resolution and enhanced contrasts offered by multi-modal 7 Tesla (7T) imaging to study the structural, vascular, functional, and connectomic changes in the brain related to the pathophysiology of COVID-19. In particular, we will reveal, in unprecedented detail, brain abnormalities resulting from the SARS-CoV-2 infection as well as shine a brighter light on possible links to loss of respiratory drive due to viral infection through the brain stem. Imaging findings will be correlated to clinical neurological symptoms and neuropsychological measures. Three patient subgroups will be recruited for our prospective study: non-cancer patients with neurological symptoms who did not require a ventilator, cancer patients with neurological symptoms who did not require a ventilator, and patients who had severe respiratory distress and required ventilation. A retrospective study will also be performed on clinical brain MRI scans for a group of COVID-19 patients with neurological symptoms, seen at Mount Sinai Health System, and outcomes of this analysis will aid in patient selection for the 7T study and additional analysis of persisting versus transient neurological effects. Our study falls within the scope of our R01 application on ?7T Neurosurgical Mapping Protocol for Endoscopic Resection of Skull Base Tumors? as we are applying similar multimodal 7T imaging techniques to reveal detailed anatomy in the brain and to characterize effects of disease in both studies. We will simply extend the cohort to include COVID-19 recovered patients and further optimize imaging in the brain stem which will be applicable to both studies. Our study aligns with the goals of the Notice of Special Interest announced by the NCI for administrative supplements on COVID-19 as it addresses potential for differential responses among diverse cancer patient populations to SARS-CoV-2 infection or COVID-19 disease in central nervous system.
We will use advanced multi-modal magnetic resonance imaging at ultrahigh magnetic fields to reveal the effects of SARS-CoV-2 virus on brain structure, function and connectivity. Effects of COVID-19 on the brain tissue resulting in persisting neurological symptoms as well as mechanisms by which the virus infects the brain will be studied through targeted image analysis.
