What question did this study set out to answer?

The study aims to understand how brain perfusion and oxygen metabolism are altered in Post-COVID-19 Syndrome and their relationship with cognitive function.

February 14, 2026Open Access

Multimodal imaging suggests potential immune-vascular contributions to altered regional brain perfusion and oxygen metabolism in Post-COVID-19 Syndrome

Puntos clave

The study aims to understand how brain perfusion and oxygen metabolism are altered in Post-COVID-19 Syndrome and their relationship with cognitive function.
Used multimodal MRI to examine brain perfusion and oxygen metabolism in individuals with Post-COVID-19 Syndrome.
Enrolled 40 individuals with prior mild SARS-CoV-2 infection: 20 with persistent fatigue and 20 matched controls.
Employed arterial spin labeling (ASL) for cerebral blood flow and measured oxygen extraction and metabolic rates.
Analyzed cognitive performance via an online assessment and measured relevant serum biomarkers.
Conducted ANCOVAs and exploratory analyses based on predefined brain regions.
PCS participants exhibited increased oxygen metabolism in the hippocampus but decreased in the anterior cingulate cortex (ACC).
Whole-brain analyses indicated heightened perfusion in specific brain regions related to emotional processing, but reduced perfusion in others without grey matter volume changes.
Cognitive performance correlated positively with higher hippocampal metabolism, whereas lower ACC metabolism linked to depressive symptoms and immune markers.

Resumen

Post-COVID-19 Syndrome (PCS) frequently presents with persistent fatigue, cognitive impairment, and emotional symptoms. Although structural brain changes remain subtle, growing evidence implicates functional and metabolic disruptions in ongoing symptomatology. We used multimodal MRI to investigate cerebral perfusion and oxygen metabolism in PCS and examined their associations with cognitive function and peripheral biomarkers. We enrolled 40 individuals with prior mild SARS-CoV-2 infection, including 20 with persistent fatigue and 20 recovered controls matched for age, sex, BMI, and acute COVID-19 severity. Participants underwent structural MRI, arterial spin labelling (ASL) to quantify regional cerebral blood flow (CBF), and asymmetric spin echo imaging to estimate oxygen extraction fraction (OEF) and cerebral metabolic rate of oxygen consumption (CMRO2). We assessed cognition using an online battery and measured serum levels of TNF-α, IL-6, IL-8, IL-13, IFN-γ, GFAP, and S100β, alongside blood routine tests. We performed ANCOVAs on predefined regions of interest (hippocampus, anterior cingulate cortex ACC, insula, amygdala, striatum), followed by Bayesian inference and exploratory whole-brain analyses. PCS participants showed increased CMRO2 in the hippocampus and decreased CMRO2 in the ACC. Subfield analysis revealed elevated OEF and CMRO2 across most hippocampal regions, excluding the entorhinal cortex. Whole-brain analyses identified increased perfusion in salience-related regions (insula, ACC, thalamus) and decreased perfusion in posterior cortical and cerebellar areas, in the absence of grey matter volume differences. Higher hippocampal metabolism positively correlated with cognitive performance, suggesting compensatory adaptation to sustain function. In contrast, lower ACC CMRO2 correlated with depressive symptoms, reduced motivation, and elevated TNF-α and GFAP, consistent with neurovascular uncoupling possibly driven by immune-glial activation. These findings reveal distinct physiological disruptions in PCS, with potential implications for stratified, metabolism-focused interventions.

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Cite This Study

Martins et al. (Tue,) studied this question.

synapsesocial.com/papers/699010382ccff479cfe56cd7 https://doi.org/https://doi.org/10.1016/j.bbi.2026.106480

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