Microstructural alterations in hypoxia-related BRAIN centers after COVID-19 by using DTI: A preliminary study.

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Balsak S., Atasoy B., Donmez Z., Yabul F. C., Daşkaya H., Akkoyunlu Y., ...More

Journal of clinical ultrasound : JCU, vol.51, no.7, pp.1276-1283, 2023 (SCI-Expanded) identifier identifier

  • Publication Type: Article / Article
  • Volume: 51 Issue: 7
  • Publication Date: 2023
  • Doi Number: 10.1002/jcu.23503
  • Journal Name: Journal of clinical ultrasound : JCU
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Biotechnology Research Abstracts, CINAHL, EMBASE, MEDLINE
  • Page Numbers: pp.1276-1283
  • Keywords: apparent diffusion coefficient, brain, COVID-19, diffusion tensor imaging, fractional anisotropy, hypoxia
  • Bezmialem Vakıf University Affiliated: Yes


Purpose: To investigate whether the diffusion tensor imaging (DTI) parameters alterations in the in hypoxia-related neuroanatomical localizations in patients after COVID-19. Additionally, the relationship between DTI findings and the clinical severity of the disease is evaluated.

Methods: The patients with COVID-19 were classified into group 1 (total patients, n = 74), group 2 (outpatient, n = 46), and group 3 (inpatient, n = 28) and control (n = 52). Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were calculated from the bulbus, pons, thalamus, caudate nucleus, globus pallidum, putamen, and hippocampus. DTI parameters were compared between groups. Oxygen saturation, D dimer and lactate dehydrogenase (LDH) values associated with hypoxia were analyzed in inpatient group. Laboratory findings were correlated with ADC and FA values.

Results: Increased ADC values in the thalamus, bulbus and pons were found in group 1 compared to control. Increased FA values in the thalamus, bulbus, globus pallidum and putamen were detected in group 1 compared to control. The FA and ADC values obtained from putamen were higher in group 3 compared to group 2. There was a negative correlation between basal ganglia and hippocampus FA values and plasma LDH values. The ADC values obtained from caudate nucleus were positively correlated with plasma D Dimer values.

Conclusion: ADC and FA changes may reveal hypoxia-related microstructural damage after COVID-19 infection. We speculated that the brainstem and basal ganglia can affected during the subacute period.

Keywords: COVID-19; apparent diffusion coefficient; brain; diffusion tensor imaging; fractional anisotropy; hypoxia.