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Exploring MRI Changes in the Olfactory Bulb of COVID-19 Patients with Long-Term Anosmia

Year 2025, , 64 - 70, 11.06.2025

Fatemeh Iranpour Mobarakeh , Mahdi Khajavi , Narges Bazgir , Farhad Mokhtarnejad , Maryam Haghighimorad , Zahra Abbasi

https://doi.org/10.26650/Tr-ENT.2025.1566365

Abstract

Objective: COVID-19 is a pandemic caused by SARS-CoV-2. Recent studies showed that it could infect the brain. The virus can cause a permanent loss of smell due to nerve damage. Magnetic resonance imaging (MRI) can help detect the structural changes in the olfactory bulb of patients with anosmia. In this article, we evaluated the morphological changes of the olfactory bulb in MRI in patients who suffered from persistent anosmia secondary to COVID-19 infection. Furthermore, we analysed the relationship between the severity of olfactory dysfunction and morphological changes in MRI.

Material and Methods: In this study, the MRI findings of patients who complained of isolated persistent anosmia after COVID-19 infection were presented. The study included patients aged 18 to 50 years who had confirmed COVID-19 and persistent anosmia for six months. We used a questionnaire to collect patient demographics, disease history, risk factors, and medical history. Patients underwent MRIs, and their olfactory bulb alterations were evaluated. The data was analysed using SPSS version 22 software.

Results: This study analysed the medical records of 15 COVID-19-positive patients admitted to the Loghman Hakim Hospital. Half of the patients had normal MRI scans. The most common disorder found was flattening or thinning of the olfactory bulb. The analysis revealed no significant relationship between Iran-SIT and MRI alterations. We categorised patients by gender. MRI abnormalities of the olfactory bulb were more prevalent in females, but this difference was not significant.

Conclusion: After conducting the research, half of the cases with post-COVID persistent anosmia had normal MRI findings. The MRI findings did not show a significant correlation with persistent anosmia in our sample.

Keywords

Magnetic resonance imaging COVID-19 anosmia

References

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  • Hoang MP, Kanjanaumporn J, Aeumjaturapat S, Chusakul S, Seresirikachorn K, Snidvongs K. Olfactory and gustatory dysfunctions in COVID-19 patients: a systematic review and meta-analysis. Asian Pac J Allergy Immunol 2020;38(3):162-9. google scholar
  • Lee Y, Min P, Lee S, Kim S-W. Prevalence and duration of acute loss of smell or taste in COVID-19 patients. J Korean Med Sci 2020;35(18):e174. google scholar
  • Moonis G, Mitchell R, Szeto B, Lalwani AK. Radiologic assessment of the sinonasal tract, nasopharynx and mastoid cavity in patients with SARS-Cov-2 infection presenting with acute neurological symptoms. Ann Otol Rhinol Laryngol 2021;130(11):1228-35. google scholar
  • Dalton P. Olfaction and anosmia in rhinosinusitis. Curr Allergy Asthma Rep 2004;4(3):230-6. google scholar
  • Whitcroft KL, Hummel T. Olfactory dysfunction in COVID-19: diagnosis and management. Jama 2020;323(24):2512-4. google scholar
  • Duprez TP, Rombaux P. Imaging the olfactory tract (cranial nerve# 1). Eur J Radiol 2010;74(2):288-98. google scholar
  • Taherkhani S, Moztarzadeh F, Mehdizadeh Seraj J, Hashemi Nazari SS, Taherkhani F, Gharehdaghi J, et al. Iran smell identification test (Iran-SIT): A modified version of the university of pennsylvania smell identification test (UPSIT) for Iranian population. Chemosensory perception 2015;8:183-91. google scholar
  • Doty RL. Psychophysical testing of smell and taste function. Handb Clin Neurol 2019;164:229-46. google scholar
  • Kandemirli SG, Altundag A, Yildirim D, Tekcan Sanli DE, Saatci O. Olfactory Bulb MRI and Paranasal Sinus CT Findings in Persistent COVID-19 Anosmia. Acad Radiol 2021;28(1):28-35. google scholar
  • Ksiazek TG, Erdman D, Goldsmith CS, Zaki SR, Peret T, Emery S, et al. A novel coronavirus associated with severe acute respiratory syndrome. N Engl J Med 2003;348(20):1953-66. google scholar
  • Wölfel R, Corman VM, Guggemos W, Seilmaier M, Zange S, Müller MA, et al. Virological assessment of hospitalized patients with COVID-2019. Nature 2020;581(7809):465-9. google scholar
  • Mastrangelo A, Bonato M, Cinque P. Smell and taste disorders in COVID-19: From pathogenesis to clinical features and outcomes. Neurosci Lett 2021;748:135694. Speth MM, Singer-Cornelius T, Oberle M, Gengler I, Brockmeier SJ, Sedaghat AR. Olfactory dysfunction and sinonasal symptomatology in COVID-19: Prevalence, severity, timing, and associated characteristics. Otolaryngol Head Neck Surg 2020;163(1):114-20. google scholar
  • Naeini AS, Karimi-Galougahi M, Raad N, Ghorbani J, Taraghi A, Haseli S, et al. Paranasal sinuses computed tomography findings in anosmia of COVID-19. Am J Otolaryngol 2020;41(6):102636. google scholar
  • Cho RH, To ZW, Yeung ZW, Tso EY, Fung KS, Chau SK, et al. COVID‐19 viral load in the severity of and recovery from olfactory and gustatory dysfunction. Laryngoscope 2020;130(11):2680-5. google scholar
  • Yan CH, Faraji F, Prajapati DP, Boone CE, DeConde AS, editors. Association of chemosensory dysfunction and Covid‐19 in patients presenting with influenza‐ like symptoms. Int Forum Allergy Rhinol 2020;10(7):806-13 google scholar
  • Lechien JR, Chiesa‐Estomba CM, Place S, Van Laethem Y, Cabaraux P, Mat Q, et al. Clinical and epidemiological characteristics of 1420 European patients with mild‐to‐moderate coronavirus disease 2019. J Intern Med 2020;288(3):335-44. google scholar
  • Paniz‐Mondolfi A, Bryce C, Grimes Z, Gordon RE, Reidy J, Lednicky J, et al. Central nervous system involvement by severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2). J Med Virol 2020;92(7):699-702. google scholar
  • Boscolo-Rizzo P, Borsetto D, Fabbris C, Spinato G, Frezza D, Menegaldo A, et al. Evolution of altered sense of smell or taste in patients with mildly symptomatic COVID-19. JAMA Otolaryngol Head Neck Surg 2020;146(8):729-32. google scholar
  • Chiesa‐Estomba CM, Lechien JoR, Radulesco T, Michel J, Sowerby LJ, Hopkins C, et al. Patterns of smell recovery in 751 patients affected by the COVID‐19 outbreak. Eur J Neurol 2020;27(11):2318-21. google scholar
  • Lechner M, Counsell N, Liu J, Eynon-Lewis N, Paun S, Lund VJ, et al. Anosmia and hyposmia in health-care workers with undiagnosed SARS-CoV-2 infection. Lancet Microbe 2020;1(4):e150. google scholar
  • Politi LS, Salsano E, Grimaldi M. Magnetic resonance imaging alteration of the brain in a patient with coronavirus disease 2019 (COVID-19) and anosmia. JAMA Neurol 2020;77(8):1028-9. google scholar
  • Laurendon T, Radulesco T, Mugnier J, Gérault M, Chagnaud C, El Ahmadi A-A, et al. Bilateral transient olfactory bulb edema during COVID-19–related anosmia. Neurology 2020;95(5):224-5. google scholar
  • Keshavarz P, Haseli S, Yazdanpanah F, Bagheri F, Raygani N, Karimi-Galougahi M. A systematic review of imaging studies in olfactory dysfunction secondary to COVID-19. Acad Radiol 2021;28(11):1530-40. google scholar
  • Tan CJW, Tan BKJ, Tan XY, Liu HT, Teo CB, See A, et al. Neuroradiological basis of COVID‐19 olfactory dysfunction: A systematic review and meta‐analysis. Laryngoscope. 2022;132(6):1260-74. google scholar
  • Brudasca I, Lisan Q, Tournegros R, Bensafi M, Ferdenzi C, Fournel A, et al., editors. Systematic MRI in persistent post‐Covid‐19 olfactory dysfunction should be reassessed. Int Forum Allergy Rhinol 2023;13(3):285-7. google scholar
  • Casez O, Willaume G, Grand S, Nemoz B, Lupo J, Kahane P, et al. Teaching NeuroImages: sARS-CoV-2–related encephalitis: MRI pattern of olfactory tract involvement. Neurology 2021;96(4):e645-e6. google scholar
  • Chiu A, Fischbein N, Wintermark M, Zaharchuk G, Yun PT, Zeineh M. COVID-19-induced anosmia associated with olfactory bulb atrophy. Neuroradiology 2021;63:147-8. google scholar
  • Tsivgoulis G, Fragkou P, Lachanis S, Palaiodimou L, Lambadiari V, Papathanasiou M, et al. Olfactory bulb and mucosa abnormalities in persistent COVID‐ 19‐induced anosmia: a magnetic resonance imaging study. Eur J Neurol 2021;28(1):e6-8. google scholar
  • Kandemirli SG, Altundag A, Yildirim D, Sanli DET, Saatci O. Olfactory bulb MRI and paranasal sinus CT findings in persistent COVID-19 anosmia. Acad Radiol 2021;28(1):28-35. google scholar
  • Karimi-Galougahi M, Yousefi-Koma A, Bakhshayeshkaram M, Raad N, Haseli S. 18FDG PET/CT scan reveals hypoactive orbitofrontal cortex in anosmia of COVID-19. Acad Radiol 2020;27(7):1042. google scholar
  • Ismail II, Gad KA. Absent blood oxygen level–dependent functional magnetic resonance imaging activation of the orbitofrontal cortex in a patient with persistent cacosmia and cacogeusia after COVID-19 infection. JAMA Neurol 2021;78(5):609-10. google scholar

Year 2025, , 64 - 70, 11.06.2025

Fatemeh Iranpour Mobarakeh , Mahdi Khajavi , Narges Bazgir , Farhad Mokhtarnejad , Maryam Haghighimorad , Zahra Abbasi

https://doi.org/10.26650/Tr-ENT.2025.1566365

Abstract

References

  • Toljan K. Letter to the editor regarding the viewpoint “evidence of the COVID-19 virus targeting the CNS: tissue distribution, host–virus interaction, and proposed neurotropic mechanism”. ACS chemical Neuroscience 2020;11(8):1192-4. google scholar
  • Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun 2020;109:102433. google scholar
  • Xu X, Chen P, Wang J, Feng J, Zhou H, Li X, et al. Evolution of the novel coronavirus from the ongoing Wuhan outbreak and modeling of its spike protein for risk of human transmission. Science China Life Sciences 2020;63:457-60. google scholar
  • Tsang KW, Ho PL, Ooi GC, Yee WK, Wang T, Chan-Yeung M, et al. A cluster of cases of severe acute respiratory syndrome in Hong Kong. N Engl J Med 2003;348(20):1977-85. google scholar
  • Assiri A, Al-Tawfiq JA, Al-Rabeeah AA, Al-Rabiah FA, Al-Hajjar S, Al-Barrak A, et al. Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study. Lancet Infec Dis 2013;13(9):752-61. google scholar
  • Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395(10223):497-506. google scholar
  • Tong JY, Wong A, Zhu D, Fastenberg JH, Tham T. The prevalence of olfactory and gustatory dysfunction in COVID-19 patients: a systematic review and metaanalysis. Otolaryngol Head Neck Surg 2020;163(1):3-11. google scholar
  • Hoang MP, Kanjanaumporn J, Aeumjaturapat S, Chusakul S, Seresirikachorn K, Snidvongs K. Olfactory and gustatory dysfunctions in COVID-19 patients: a systematic review and meta-analysis. Asian Pac J Allergy Immunol 2020;38(3):162-9. google scholar
  • Lee Y, Min P, Lee S, Kim S-W. Prevalence and duration of acute loss of smell or taste in COVID-19 patients. J Korean Med Sci 2020;35(18):e174. google scholar
  • Moonis G, Mitchell R, Szeto B, Lalwani AK. Radiologic assessment of the sinonasal tract, nasopharynx and mastoid cavity in patients with SARS-Cov-2 infection presenting with acute neurological symptoms. Ann Otol Rhinol Laryngol 2021;130(11):1228-35. google scholar
  • Dalton P. Olfaction and anosmia in rhinosinusitis. Curr Allergy Asthma Rep 2004;4(3):230-6. google scholar
  • Whitcroft KL, Hummel T. Olfactory dysfunction in COVID-19: diagnosis and management. Jama 2020;323(24):2512-4. google scholar
  • Duprez TP, Rombaux P. Imaging the olfactory tract (cranial nerve# 1). Eur J Radiol 2010;74(2):288-98. google scholar
  • Taherkhani S, Moztarzadeh F, Mehdizadeh Seraj J, Hashemi Nazari SS, Taherkhani F, Gharehdaghi J, et al. Iran smell identification test (Iran-SIT): A modified version of the university of pennsylvania smell identification test (UPSIT) for Iranian population. Chemosensory perception 2015;8:183-91. google scholar
  • Doty RL. Psychophysical testing of smell and taste function. Handb Clin Neurol 2019;164:229-46. google scholar
  • Kandemirli SG, Altundag A, Yildirim D, Tekcan Sanli DE, Saatci O. Olfactory Bulb MRI and Paranasal Sinus CT Findings in Persistent COVID-19 Anosmia. Acad Radiol 2021;28(1):28-35. google scholar
  • Ksiazek TG, Erdman D, Goldsmith CS, Zaki SR, Peret T, Emery S, et al. A novel coronavirus associated with severe acute respiratory syndrome. N Engl J Med 2003;348(20):1953-66. google scholar
  • Wölfel R, Corman VM, Guggemos W, Seilmaier M, Zange S, Müller MA, et al. Virological assessment of hospitalized patients with COVID-2019. Nature 2020;581(7809):465-9. google scholar
  • Mastrangelo A, Bonato M, Cinque P. Smell and taste disorders in COVID-19: From pathogenesis to clinical features and outcomes. Neurosci Lett 2021;748:135694. Speth MM, Singer-Cornelius T, Oberle M, Gengler I, Brockmeier SJ, Sedaghat AR. Olfactory dysfunction and sinonasal symptomatology in COVID-19: Prevalence, severity, timing, and associated characteristics. Otolaryngol Head Neck Surg 2020;163(1):114-20. google scholar
  • Naeini AS, Karimi-Galougahi M, Raad N, Ghorbani J, Taraghi A, Haseli S, et al. Paranasal sinuses computed tomography findings in anosmia of COVID-19. Am J Otolaryngol 2020;41(6):102636. google scholar
  • Cho RH, To ZW, Yeung ZW, Tso EY, Fung KS, Chau SK, et al. COVID‐19 viral load in the severity of and recovery from olfactory and gustatory dysfunction. Laryngoscope 2020;130(11):2680-5. google scholar
  • Yan CH, Faraji F, Prajapati DP, Boone CE, DeConde AS, editors. Association of chemosensory dysfunction and Covid‐19 in patients presenting with influenza‐ like symptoms. Int Forum Allergy Rhinol 2020;10(7):806-13 google scholar
  • Lechien JR, Chiesa‐Estomba CM, Place S, Van Laethem Y, Cabaraux P, Mat Q, et al. Clinical and epidemiological characteristics of 1420 European patients with mild‐to‐moderate coronavirus disease 2019. J Intern Med 2020;288(3):335-44. google scholar
  • Paniz‐Mondolfi A, Bryce C, Grimes Z, Gordon RE, Reidy J, Lednicky J, et al. Central nervous system involvement by severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2). J Med Virol 2020;92(7):699-702. google scholar
  • Boscolo-Rizzo P, Borsetto D, Fabbris C, Spinato G, Frezza D, Menegaldo A, et al. Evolution of altered sense of smell or taste in patients with mildly symptomatic COVID-19. JAMA Otolaryngol Head Neck Surg 2020;146(8):729-32. google scholar
  • Chiesa‐Estomba CM, Lechien JoR, Radulesco T, Michel J, Sowerby LJ, Hopkins C, et al. Patterns of smell recovery in 751 patients affected by the COVID‐19 outbreak. Eur J Neurol 2020;27(11):2318-21. google scholar
  • Lechner M, Counsell N, Liu J, Eynon-Lewis N, Paun S, Lund VJ, et al. Anosmia and hyposmia in health-care workers with undiagnosed SARS-CoV-2 infection. Lancet Microbe 2020;1(4):e150. google scholar
  • Politi LS, Salsano E, Grimaldi M. Magnetic resonance imaging alteration of the brain in a patient with coronavirus disease 2019 (COVID-19) and anosmia. JAMA Neurol 2020;77(8):1028-9. google scholar
  • Laurendon T, Radulesco T, Mugnier J, Gérault M, Chagnaud C, El Ahmadi A-A, et al. Bilateral transient olfactory bulb edema during COVID-19–related anosmia. Neurology 2020;95(5):224-5. google scholar
  • Keshavarz P, Haseli S, Yazdanpanah F, Bagheri F, Raygani N, Karimi-Galougahi M. A systematic review of imaging studies in olfactory dysfunction secondary to COVID-19. Acad Radiol 2021;28(11):1530-40. google scholar
  • Tan CJW, Tan BKJ, Tan XY, Liu HT, Teo CB, See A, et al. Neuroradiological basis of COVID‐19 olfactory dysfunction: A systematic review and meta‐analysis. Laryngoscope. 2022;132(6):1260-74. google scholar
  • Brudasca I, Lisan Q, Tournegros R, Bensafi M, Ferdenzi C, Fournel A, et al., editors. Systematic MRI in persistent post‐Covid‐19 olfactory dysfunction should be reassessed. Int Forum Allergy Rhinol 2023;13(3):285-7. google scholar
  • Casez O, Willaume G, Grand S, Nemoz B, Lupo J, Kahane P, et al. Teaching NeuroImages: sARS-CoV-2–related encephalitis: MRI pattern of olfactory tract involvement. Neurology 2021;96(4):e645-e6. google scholar
  • Chiu A, Fischbein N, Wintermark M, Zaharchuk G, Yun PT, Zeineh M. COVID-19-induced anosmia associated with olfactory bulb atrophy. Neuroradiology 2021;63:147-8. google scholar
  • Tsivgoulis G, Fragkou P, Lachanis S, Palaiodimou L, Lambadiari V, Papathanasiou M, et al. Olfactory bulb and mucosa abnormalities in persistent COVID‐ 19‐induced anosmia: a magnetic resonance imaging study. Eur J Neurol 2021;28(1):e6-8. google scholar
  • Kandemirli SG, Altundag A, Yildirim D, Sanli DET, Saatci O. Olfactory bulb MRI and paranasal sinus CT findings in persistent COVID-19 anosmia. Acad Radiol 2021;28(1):28-35. google scholar
  • Karimi-Galougahi M, Yousefi-Koma A, Bakhshayeshkaram M, Raad N, Haseli S. 18FDG PET/CT scan reveals hypoactive orbitofrontal cortex in anosmia of COVID-19. Acad Radiol 2020;27(7):1042. google scholar
  • Ismail II, Gad KA. Absent blood oxygen level–dependent functional magnetic resonance imaging activation of the orbitofrontal cortex in a patient with persistent cacosmia and cacogeusia after COVID-19 infection. JAMA Neurol 2021;78(5):609-10. google scholar
There are 38 citations in total.

Details

Primary Language English
Subjects Otorhinolaryngology
Journal Section Research Articles
Authors

Fatemeh Iranpour Mobarakeh 0009-0006-7643-9417

Mahdi Khajavi 0009-0006-0986-1976

Narges Bazgir 0000-0002-6443-9448

Farhad Mokhtarnejad 0000-0001-6098-6455

Maryam Haghighimorad 0000-0003-0086-9446

Zahra Abbasi 0009-0007-2486-8698

Publication Date June 11, 2025
Submission Date October 21, 2024
Acceptance Date January 27, 2025
Published in Issue Year 2025

Cite

APA Iranpour Mobarakeh, F., Khajavi, M., Bazgir, N., Mokhtarnejad, F., et al. (2025). Exploring MRI Changes in the Olfactory Bulb of COVID-19 Patients with Long-Term Anosmia. The Turkish Journal of Ear Nose and Throat, 35(2), 64-70. https://doi.org/10.26650/Tr-ENT.2025.1566365
AMA Iranpour Mobarakeh F, Khajavi M, Bazgir N, Mokhtarnejad F, Haghighimorad M, Abbasi Z. Exploring MRI Changes in the Olfactory Bulb of COVID-19 Patients with Long-Term Anosmia. Tr-ENT. June 2025;35(2):64-70. doi:10.26650/Tr-ENT.2025.1566365
Chicago Iranpour Mobarakeh, Fatemeh, Mahdi Khajavi, Narges Bazgir, Farhad Mokhtarnejad, Maryam Haghighimorad, and Zahra Abbasi. “Exploring MRI Changes in the Olfactory Bulb of COVID-19 Patients With Long-Term Anosmia”. The Turkish Journal of Ear Nose and Throat 35, no. 2 (June 2025): 64-70. https://doi.org/10.26650/Tr-ENT.2025.1566365.
EndNote Iranpour Mobarakeh F, Khajavi M, Bazgir N, Mokhtarnejad F, Haghighimorad M, Abbasi Z (June 1, 2025) Exploring MRI Changes in the Olfactory Bulb of COVID-19 Patients with Long-Term Anosmia. The Turkish Journal of Ear Nose and Throat 35 2 64–70.
IEEE F. Iranpour Mobarakeh, M. Khajavi, N. Bazgir, F. Mokhtarnejad, M. Haghighimorad, and Z. Abbasi, “Exploring MRI Changes in the Olfactory Bulb of COVID-19 Patients with Long-Term Anosmia”, Tr-ENT, vol. 35, no. 2, pp. 64–70, 2025, doi: 10.26650/Tr-ENT.2025.1566365.
ISNAD Iranpour Mobarakeh, Fatemeh et al. “Exploring MRI Changes in the Olfactory Bulb of COVID-19 Patients With Long-Term Anosmia”. The Turkish Journal of Ear Nose and Throat 35/2 (June 2025), 64-70. https://doi.org/10.26650/Tr-ENT.2025.1566365.
JAMA Iranpour Mobarakeh F, Khajavi M, Bazgir N, Mokhtarnejad F, Haghighimorad M, Abbasi Z. Exploring MRI Changes in the Olfactory Bulb of COVID-19 Patients with Long-Term Anosmia. Tr-ENT. 2025;35:64–70.
MLA Iranpour Mobarakeh, Fatemeh et al. “Exploring MRI Changes in the Olfactory Bulb of COVID-19 Patients With Long-Term Anosmia”. The Turkish Journal of Ear Nose and Throat, vol. 35, no. 2, 2025, pp. 64-70, doi:10.26650/Tr-ENT.2025.1566365.
Vancouver Iranpour Mobarakeh F, Khajavi M, Bazgir N, Mokhtarnejad F, Haghighimorad M, Abbasi Z. Exploring MRI Changes in the Olfactory Bulb of COVID-19 Patients with Long-Term Anosmia. Tr-ENT. 2025;35(2):64-70.