嗅觉缺失的新冠肺炎患者嗅球的磁共振成像结果：系统综述

doi:10.24920/003982

摘要/Abstract

摘要：

背景嗅觉缺失是新冠病毒（SARS-CoV-2）感染者的症状之一。在嗅觉缺失患者中,SARS-CoV-2可暂时改变嗅觉神经细胞和嗅球（OB）的信号传导过程,最终损害嗅觉上皮的结构,导致嗅觉通道的永久性紊乱。这种受损结构可在磁共振成像（MRI）中显示。
方法两名研究人员独立搜索了四个数据库,包括PubMed、ProQuest、Scopus和Web of Science,以检索截至2020年11月11日的相关记录。检索不限时间、空间和语言。同时也检索了Google Scholar,但仅限于2020年的数据。根据PRISMA流程图对所有发现的文章进行了系统综述。定性研究、病例报告、社论、读者来信和其他非原创研究被排除在本系统分析之外。
结果初步检索出434条记录。在查阅了标题和摘要后,选出74篇文章;最后,对8篇文章进行了全文审阅。结果显示在新冠肺炎患者可见嗅裂（OC）宽度和体积增加、OC完全或部分破坏以及OC完全阻塞。OB存在明显的变形和退化,并有细微的不对称。在这些研究中,计算机断层扫描（CT）、MRI和正电子发射断层扫描（PET）用于检测嗅觉缺失的结果。
结论新冠肺炎患者OC的变化大于OB,主要是由于OC的炎症反应和免疫反应。然而,由神经或血管疾病所致的OB变化较少见。局部类固醇治疗和局部生理盐水可能有益。

关键词: 磁共振成像, 嗅球, 新冠肺炎, 嗅觉缺失

Abstract:

Background Anosmia is one of the symptoms in individuals with SARS-CoV-2 infection. In anosmic patients, SARS-CoV-2 temporarily alters the signaling process in olfactory nerve cells and olfactory bulb (OB), which eventually damages the structure of the olfactory epithelium, leading to a permanent disorder in the olfactory pathway that this damaged structure is showed in MRI imaging
Method Two investigators independently searched four databases consisting of PubMed, ProQuest, Scopus, and Web of Science for relevant records as of November 11, 2020 with no time, space, and language restrictions. Google Scholar was also searched for the related resources within the time limit of 2020. All the found articles were reviewed based on the PRISMA flow diagram. Qualitative studies, case reports, editorials, letters, and other non-original studies were excluded from this systematic analysis.
Results Initial search yielded 434 records. After reviewing the titles and abstracts, we selected 74 articles; finally, 8 articles were depicted to be investigated and read in full text. The obtained results showed an increase in the width and volume of the olfactory cleft (OC), complete or partial destruction of OC, and complete occlusion of OC in COVID-19 patients. Deformation and degeneration as well as a subtle asymmetry were evident in the OBs. Computed tomography (CT), meganetic resonance imaging (MRI), and positron emission tomography (PET) were used to detect the outcomes of anosmia in these studies.
Conclusions The changes in OC are greater than those in OB in patients with COVID-19, mainly due to the inflammatory and immune responses in OC. However, fewer changes in OB are due to neurological or vascular disorders. Topical steroid therapy and topical saline can be helpful.

Key words: magnetic resonance imaging, olfactory bulb, COVID-19, anosmia

Atefeh Beigi-khoozani, Amirmohammad Merajikhah, Mahdieh Soleimani. Magnetic Resonance Imaging Findings of Olfactory Bulb in Anosmic Patients with COVID-19: A Systematic Review[J].Chinese Medical Sciences Journal, 2022, 37(1): 23-30.

图/表 3

References	Study type	Number of patients	Cause of OD	Assessment		MRI manifestations
References	Study type	Number of patients	Cause of OD	Odor assessment	Imaging modality	Olfactory cleft (OC)	Olfactory bulb (OB)
Klironomos S, et al^[27]	Retrospective cohort study	185	SARS-CoV-2 infection	RT-PCR	CT and MRI	None	Abnormal OB signals
Altundag A, et al^[28]	Prospective	91	SARS-CoV-2 infection; Non-SARS-CoV-2 infection	RT-PCR; Sniffin’ sticks test	CT and MRI	Increased widths and volume of OC	No significant difference in OB volumes and olfactory sulcus depths on MRI among anosmic patients
Eliezer M, et al^[29]	Prospective case-controlled	20	SARS-CoV-2 infection	PCR; Visual Olfactive Score (VOS)	MRI	Complete obstruction of the OC occured in 95% of patients at the early stage; no obstruction was seen was seen during the 1-month follow-up	On the first MRI session, no significant difference in OB volume. At the 1-month follow-up visit, no significant difference in OB volume. Normal morphology of the OB
Niesen M, et al^[30]	Prospective	12	SARS-CoV-2 infection	RT-PCR	PET; MRI with fluorodeoxyglucose	Bilateral obliteration of the OC in 50% of patients	Subtle asymmetry in OB
Kandemirli SG, et al^[31]	Prospective	23	COVID-19	PCR; Sniffin’ sticks test	CT; MRI	High rate of OC opacification	Reduction in OB volume; altered OB shape; signal abnormalities
Aragão MFVV, et al^[32]	Retrospective	5	SARS-CoV-2 infection	Not performed	MRI with contrast enhancement	None	Abnormal OB intensities in all patients
Brookes N, et al^[33]	Case series	4	COVID-19	University of Pennsylvania Smell Identification Test (UPSIT)	MRI	None	In two cases, MRI showed normal OB and cribriform plates, along with minimal mucosal thickening in the ethmoid sinuses.
Coolen T, et al^[34]	Prospective, case series	19	SARS-CoV-2 infection	PCR; chest CT	MRI and PET	Asymmetric olfactory bulb was observed, with or without obliteration of OC. Obliteration of OC and ipsilateral inflammation of OB	Asymmetric OB, inflation of OB

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Result of G immunoglobulin	Duration of effectiveness	Recovery time		Route of administration	Medicines in treatment
Result of G immunoglobulin	Duration of effectiveness	Total	Partial	Route of administration	Medicines in treatment
Positive	7 days	2 - 3 weeks	1 week (40% - 85%)	Oral	Steroids
Positive	7 days	2 - 3 weeks	1 week (40% - 85%)	Local	Steroid drops
Positive	3 days	2 weeks	1 week (85%)	Local	Ephedrine
Positive	3 days	2 weeks	1 week (85%)	Local	Betnesol
Positive	3 days	2 weeks	6 days	Oral	Prednisolone
None	8 days	2 weeks	8 days	Local	Nasal saline irrigations

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