Virtual Biopsy: A Reality Thanks to Advances in Radiology

Brain MR imaging of a woman in her 40’s with confirmed COVID-19 shows injury of the olfactory bulbs, within 7 days of onset of the disease. A real-time polymerase chain reaction of a nasopharyngeal swab detected Severe Acute Respiratory Syndrome coronavirus 2, which was negative on her CSF. The MR imaging shows that the olfactory bulbs are oval images with signal intensity similar to that of gray matter on precontrast T1WI (A, arrows), being hypointense. On postcontrast T1WI (B, arrows), the olfactory bulbs show abnormal enhancement and become hyperintense, suggesting injury with breakdown of the brain-blood barrier. Two months later, the follow-up MR imaging shows that the contrast enhancement of the olfactory bulbs has completely disappeared and they have a normal appearance, being hypointense and similar to the gray matter on coronal postcontrast T1WI (C, arrows).