Metabolic brain changes in post-acute COVID-19: systematic review and meta-analysis of [18F]-FDG-PET findings.

IF 2.9 3区医学 Q1 ANATOMY & MORPHOLOGY

Brain Structure & Function Pub Date : 2025-08-07 DOI:10.1007/s00429-025-02997-3

Izabella Fernanda Bastos Siqueira, Lais Almeida Figueiredo, Camila Emanuele Moreira Fernandes, Leandro Pinheiro Cintra, Glauber Fernandes de Oliveira, Maria Angélica Rios, Ricardo Maciel, Rodrigo Ferretjans, Nathalia Sernizon Guimarães, Luiz Alexandre Viana Magno

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Abstract

Individuals with long COVID exhibit neurological and psychiatric symptoms that often persist well beyond the initial SARS-CoV-2 infection. Studies using [18F]-FDG positron emission tomography (FDG-PET) have revealed diverse abnormalities in brain glucose metabolism during the post-acute phase of COVID-19. We conducted a systematic review and meta-analysis to assess the spatial distribution and heterogeneity of brain metabolic changes in patients in the post-acute phase of COVID-19 relative to controls. We searched the MEDLINE, EMBASE, and CENTRAL databases in June 2025 for studies reporting FDG-PET data in patients with post-acute COVID-19 who have persistent neurological symptoms. Of the 14 eligible studies (584 scans), 13 reported glucose hypometabolism across frontoparietal regions, with the frontal cortex being the most consistently affected. This finding was confirmed by meta-analysis, which revealed a large and significant effect in the frontal cortex (Hedges' g = 1.34; 95% CI: 0.79-1.88; p < 0.001), despite high heterogeneity (I² = 93.6%). The systematic review indicates that brain metabolism generally improves over time, with widely varying recovery timelines, and consistently correlates hypometabolism with neurological symptom burden. These findings underscore the clinical relevance of frontoparietal hypometabolism in post-acute COVID-19 and its association with neurocognitive deficits, highlighting the need for longitudinal, quantitative PET studies to elucidate temporal dynamics and inform therapeutic development.

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COVID-19急性后脑代谢性变化：[18F]-FDG-PET结果的系统回顾和meta分析

长冠状病毒感染者表现出神经和精神症状，这些症状通常持续到最初的SARS-CoV-2感染后很久。使用[18F]-FDG正电子发射断层扫描（FDG-PET）的研究揭示了COVID-19急性期后脑糖代谢的多种异常。我们进行了系统回顾和荟萃分析，以评估COVID-19急性期后患者相对于对照组的脑代谢变化的空间分布和异质性。我们于2025年6月检索了MEDLINE、EMBASE和CENTRAL数据库，寻找报告急性后具有持续神经系统症状的COVID-19患者FDG-PET数据的研究。在14项符合条件的研究（584次扫描）中，13项报告了额顶叶区域的葡萄糖代谢低下，其中额皮质受到的影响最为一致。荟萃分析证实了这一发现，显示额叶皮层的影响很大且显著(Hedges' g = 1.34；95% ci: 0.79-1.88；p 2 = 93.6%)。系统评价表明，随着时间的推移，脑代谢通常会改善，但恢复时间差异很大，并且代谢降低与神经症状负担始终相关。这些发现强调了COVID-19急性后额顶叶低代谢的临床相关性及其与神经认知缺陷的关联，强调了纵向定量PET研究的必要性，以阐明时间动态并为治疗开发提供信息。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Brain Structure & Function 医学-解剖学与形态学

CiteScore

6.00

自引率

6.50%

发文量

168

审稿时长

8 months

期刊介绍： Brain Structure & Function publishes research that provides insight into brain structure−function relationships. Studies published here integrate data spanning from molecular, cellular, developmental, and systems architecture to the neuroanatomy of behavior and cognitive functions. Manuscripts with focus on the spinal cord or the peripheral nervous system are not accepted for publication. Manuscripts with focus on diseases, animal models of diseases, or disease-related mechanisms are only considered for publication, if the findings provide novel insight into the organization and mechanisms of normal brain structure and function.