Brain-related complications of COVID-19 and the role of FDG-PET in detecting vascular and non-vascular defects throughout the body

Objectives: 1. Highlight the impact of COVID-19 on the brain 2. Describe the utility of FDG-PET imaging in the detection of vascular and non-vascular complications and their association with COVID-19

Methods: Major medical databases, such as PubMed, Google Scholar and Web of Science, will be utilized to acquire relevant literature assessing the effects of COVID-19 on the central nervous system and the respective vasculature. For background purposes, virologic and pathologic studies assessing the brain-related consequences of COVID-19 will be compiled. Subsequently, a similar search will collect FDG-PET neuroimaging studies of COVID-19. These studies will be assessed for strength on the basis of study design, study size and findings. Thereafter, there will be a synthesis of the findings to answer the aforementioned objectives.

Results: Coronavirus Disease 2019 (COVID-19) is an infectious disease that primarily involves the respiratory system but may also present with brain-related and extra-pulmonary manifestations. The most common neurological deficits associated with COVID-19 are stroke and encephalitis but also include impaired blood flow to the brain via hemorrhages and altered mental states that can lead to psychosis. PET imaging has demonstrated considerable use in the identification of veno-occlusive and thrombo-embolic events as well as psychosis and inflammation. As patients presenting for PET imaging typically do so for reasons apart from COVID-19 (i.e. cancer imaging) and have a higher risk of developing complications and death from COVID-19, the diagnosis of adverse events stemming from the primary disease is of critical importance. Conclusions FDG-PET can characterize the extent of systemic disease in COVID-19 patients and provide value in the early identification of complications that may make patients more susceptible to the harmful respiratory and systemic side effects of COVID-19. Severe neurological ramifications of COVID-19 have been noted such as the increased prevalence of acute cerebrovascular incidents. In these contexts, emerging literature has proven that the use of FDG-PET can be useful in monitoring the neurological manifestations the COVID-19 virus.