# Brain microstructural alterations in COVID-19: a systematic review of diffusion weighted imaging studies **Authors:** Ali Jahanshahi, Soheil Mohammadi, Mohammad Amin Salehi, Mahsa Dolatshahi, Sina Mirakhori, Negin Frounchi, Seyed Sina Zakavi, Hamid Harandi, Hosein Ghasempour, Cyrus A. Raji PMC · DOI: 10.1007/s11682-026-01084-3 · Brain Imaging and Behavior · 2026-03-14 ## TL;DR This paper reviews how the brain's white matter is affected in COVID-19 patients using diffusion imaging, highlighting consistent changes in specific brain regions. ## Contribution The study systematically compiles and analyzes diffusion imaging findings to reveal consistent white matter alterations in COVID-19. ## Key findings - Significant changes in MD and FA were observed in longitudinal fasciculi, thalamic radiations, and corpus callosum. - Altered white matter integrity is linked to psychiatric and cognitive symptoms in post-COVID-19 patients. - Consistent results were found for changes in corticospinal tract and uncinate fasciculi across studies. ## Abstract Following its emergence in Wuhan, COVID-19 has been associated with neurological sequalae, pathophysiological basis of which has been under investigation from the early reports. Herein, we aim to provide a comprehensive overview on white matter microstructural findings in COVID-19 patents. We performed a systematic literature search on PubMed, Scopus, Web of Science, and EMBASE databases on February 9th, 2025, using the combination of keywords related to COVID-19, DTI, and NODDI. Study selection and data extraction was performed to provide a qualitative synthesis of the data. Mean diffusivity (MD) and fractional anisotropy (FA) were the most reported diffusion parameters. Significant alterations in diffusion parameters of longitudinal fasciculi, thalamic radiations, corpus callosum (CC), fronto-occipital fasciculus (FOF), cortico-spinal tract (CST) and uncinate fasciculi (UF) were repeatedly reported among in the studies, of which the results on changes in CR and LF were almost consistent. The observed changes in white matter microstructural integrity are associated with the psychiatric and cognitive symptoms in post-COVID-19 phase. This observation warrants long-term follow-up of COVID-19 patients for the potential neurological sequalae of this disease. The online version contains supplementary material available at 10.1007/s11682-026-01084-3. ## Linked entities - **Diseases:** COVID-19 (MONDO:0100096) ## Full-text entities - **Genes:** IL6 (interleukin 6) [NCBI Gene 3569] {aka BSF-2, BSF2, CDF, HGF, HSF, IFN-beta-2}, SLF1 (SMC5/6 complex localization factor 1) [NCBI Gene 84250] {aka ANKRD32, BRCTD1, BRCTx, hNSE5}, SLF2 (SMC5/6 complex localization factor 2) [NCBI Gene 55719] {aka ATELS1, C10orf6, FAM178A, hNSE6}, FOXK2 (forkhead box K2) [NCBI Gene 3607] {aka ILF, ILF-1, ILF1, nGTBP}, ACE2 (angiotensin converting enzyme 2) [NCBI Gene 59272] {aka ACEH}, ATR (ATR checkpoint kinase) [NCBI Gene 545] {aka FCTCS, FRP1, MEC1, SCKL, SCKL1}, TMPRSS2 (transmembrane serine protease 2) [NCBI Gene 7113] {aka PRSS10}, CRP (C-reactive protein) [NCBI Gene 1401] {aka PTX1}, PAG1 (phosphoprotein membrane anchor with glycosphingolipid microdomains 1) [NCBI Gene 55824] {aka CBP, PAG}, CST12P (cystatin 12, pseudogene) [NCBI Gene 106478911] {aka Cst, Ctes4, E2} - **Diseases:** impaired visual recognition, memory, and auditory verbal learning (MESH:D014786), -CM (MESH:D008881), DKI (MESH:C564543), sinusitis (MESH:D012852), deaths (MESH:D003643), demyelination (MESH:D003711), Herpes simplex encephalitis (MESH:D020803), CC infarction (MESH:D007238), Depression (MESH:D003866), atrophy (MESH:D001284), encephalopathy (MESH:D001927), BDI (MESH:D057767), PTSD (MESH:D013313), insomnia (MESH:D007319), WM (MESH:D056784), vertical occipital fasciculus (MESH:D009759), Coronavirus (MESH:D018352), anorexia nervosa (MESH:D000856), Infected (MESH:D007239), dementia (MESH:D003704), axonal damage (MESH:D001480), Viral infections (MESH:D014777), strokes (MESH:D020521), schizophrenia (MESH:D012559), MDD (MESH:D003865), attention impairment (MESH:D001289), AF (MESH:D012607), episodic memory (MESH:C580065), neurodegeneration (MESH:D019636), loss of smell (MESH:D000086582), inflammation (MESH:D007249), neuronal damage (MESH:D009410), TBSS (MESH:D008569), headache (MESH:D006261), Anxiety (MESH:D001007), neurological sequelae (MESH:D009422), shortness of breath (MESH:D004417), COVID-19 infection (MESH:D000086382), endotheliitis (MESH:D005642), mood disorders (MESH:D019964), sleep disorders (MESH:D012893), Parkinson disease (MESH:D010300), OCL (MESH:D003072), Fatigue (MESH:D005221), Alzheimer disease (MESH:D000544), AD (MESH:C537791), neuropsychiatric disorders (MESH:D001523), cough (MESH:D003371), OD (MESH:D000857), cognitive symptoms (MESH:D019954), neuroinflammation (MESH:D000090862), obsessive-compulsive disorder (MESH:D009771), cellular injury (MESH:D004806), Anxiety Disorder (MESH:D001008), neurological sequalae (MESH:D009461), pain (MESH:D010146), MD (MESH:D008228), GAD (MESH:C000726808), AFD (MESH:D000071075), Long Covid (MESH:D000094024) - **Chemicals:** Covid (-), glucose (MESH:D005947), Water (MESH:D014867) - **Species:** Severe acute respiratory syndrome coronavirus 2 (no rank) [taxon 2697049], Homo sapiens (human, species) [taxon 9606] ## Full text _Full body text omitted from this summary view._ Fetch the complete paper as Markdown: https://tomesphere.com/paper/PMC12988982/full.md ## Figures 2 figures with captions in the complete paper: https://tomesphere.com/paper/PMC12988982/full.md ## References 1 references — full list in the complete paper: https://tomesphere.com/paper/PMC12988982/full.md --- Source: https://tomesphere.com/paper/PMC12988982