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Many of these changes are proposed to result from para-infectious and\/or post-infection immune responses. Clinical symptoms such as fatigue, breathlessness, and chest pain are frequently reported in post-hospitalized coronavirus disease 2019 (COVID-19) patients. We propose that these symptoms are in part due to damage to key neuromodulatory brainstem nuclei. While brainstem involvement has been demonstrated in the acute phase of the illness, the evidence of long-term brainstem change on MRI is inconclusive. We therefore used ultra-high field (7 T) quantitative susceptibility mapping (QSM) to test the hypothesis that brainstem abnormalities persist in post-COVID patients and that these are associated with persistence of key symptoms.<\/jats:p>\n               <jats:p>We used 7 T QSM data from 30 patients, scanned 93\u2013548 days after hospital admission for COVID-19 and compared them to 51 age-matched controls without prior history of COVID-19 infection. We correlated the patients\u2019 QSM signals with disease severity (duration of hospital admission and COVID-19 severity scale), inflammatory response during the acute illness (C-reactive protein, D-dimer and platelet levels), functional recovery (modified Rankin scale), depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder-7).<\/jats:p>\n               <jats:p>In COVID-19 survivors, the MR susceptibility increased in the medulla, pons and midbrain regions of the brainstem. Specifically, there was increased susceptibility in the inferior medullary reticular formation and the raphe pallidus and obscurus. In these regions, patients with higher tissue susceptibility had worse acute disease severity, higher acute inflammatory markers, and significantly worse functional recovery.<\/jats:p>\n               <jats:p>This study contributes to understanding the long-term effects of COVID-19 and recovery. Using non-invasive ultra-high field 7 T MRI, we show evidence of brainstem pathophysiological changes associated with inflammatory processes in post-hospitalized COVID-19 survivors.<\/jats:p>","DOI":"10.1093\/brain\/awae215","type":"journal-article","created":{"date-parts":[[2024,10,8]],"date-time":"2024-10-08T03:07:27Z","timestamp":1728356847000},"page":"4121-4130","source":"Crossref","is-referenced-by-count":42,"title":["Quantitative susceptibility mapping at 7 T in COVID-19: brainstem effects and outcome associations"],"prefix":"10.1093","volume":"147","author":[{"given":"Catarina","family":"Rua","sequence":"first","affiliation":[{"name":"Wolfson Brain Imaging Centre, University of Cambridge , Cambridge CB2 0QQ ,","place":["UK"]},{"name":"University of Cambridge Centre for Parkinson-plus, University of Cambridge , Cambridge CB2 0QQ ,","place":["UK"]},{"name":"Invicro, Invicro London, Burlington Danes Building, Imperial College London , London W12 0NN ,","place":["UK"]},{"name":"Department of Clinical Neurosciences, University of Cambridge , Cambridge CB2 0QQ ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1239-9608","authenticated-orcid":false,"given":"Betty","family":"Raman","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Radcliffe Department of Medicine and Oxford University Hospitals NHS Foundation Trust, University of Oxford , Oxford OX3 9DU ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher T","family":"Rodgers","sequence":"additional","affiliation":[{"name":"Wolfson Brain Imaging Centre, University of Cambridge , Cambridge CB2 0QQ ,","place":["UK"]},{"name":"Department of Clinical Neurosciences, University of Cambridge , Cambridge CB2 0QQ 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J","family":"Sawcer","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences, University of Cambridge , Cambridge CB2 0QQ ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne G","family":"Outtrim","sequence":"additional","affiliation":[{"name":"Division of Anaesthesia, University of Cambridge , Cambridge CB2 0QQ ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria C","family":"Lupson","sequence":"additional","affiliation":[{"name":"Wolfson Brain Imaging Centre, University of Cambridge , Cambridge CB2 0QQ ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6955-9601","authenticated-orcid":false,"given":"Emmanuel A","family":"Stamatakis","sequence":"additional","affiliation":[{"name":"Wolfson Brain Imaging Centre, University of Cambridge , Cambridge CB2 0QQ ,","place":["UK"]},{"name":"Department of Clinical Neurosciences, University of Cambridge , Cambridge CB2 0QQ ,","place":["UK"]},{"name":"Division of Anaesthesia, University of Cambridge , Cambridge CB2 0QQ ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guy B","family":"Williams","sequence":"additional","affiliation":[{"name":"Wolfson Brain Imaging Centre, University of Cambridge , Cambridge CB2 0QQ ,","place":["UK"]},{"name":"Department of Clinical Neurosciences, University of Cambridge , Cambridge CB2 0QQ ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7159-7025","authenticated-orcid":false,"given":"William T","family":"Clarke","sequence":"additional","affiliation":[{"name":"Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford , Oxford OX3 9DA 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