Neuroimaging Findings of Multisystem Inflammatory syndrome in Children (MIS-C) Associated with COVID-19

Background: Multisystem inflammatory syndrome in children (MIS-C) is a serious post-infectious complication of SARS-CoV-2, marked by systemic hyperinflammation with frequent neurological involvement. Neuroimaging is pivotal for detecting CNS pathology, yet data remain limited. This study aimed to characterize the neuroimaging features and clinical outcomes in MIS-C patients with neurological symptoms. Methods: This retrospective cross-sectional study included 48 pediatric patients (mean age 9.3 ± 1.2 years; range 4–18 years; 58.3% boys) with neurological symptoms within 2–4 weeks of confirmed SARS-CoV-2 infection meeting Centers for Disease Control and prevention criteria (CDC) for MIS-C. Clinical and laboratory evaluations were followed by brain MRI (and spinal MRI when indicated). Imaging included basic MRI, diffusion-weighted imaging (DWI), ADC mapping, and contrast-enhanced sequences. Results: Encephalitis was the most frequent diagnosis (20.8%), followed by ADEM and Guillain-Barré syndrome (each 16.7%). Neurological symptoms included headache (66.7%), seizures (45.8%), encephalopathy (41.7%), and gait disturbances (37.5%). MRI findings were nonconfluent multifocal white matter hyperintensities (33.3%), confluent lesions (29.2%). Splenial lesions (62.5%), and diffusion restriction (75%). Normal brain MRI occurred in 16.7%. Spinal MRI was normal in 70.8%, while long segment myelitis (16.7%) and caudaequina enhancement (12.5%) were observed. Radiological resolution occurred in 66.7%. Clinically, 66.7% had a good outcome; poor outcome and death occurred in 16.7% each. Mean hospital stay was 16.8 ± 9.2 days Conclusion: MIS-C associated with COVID-19 can cause diverse neuroimaging abnormalities, particularly white matter and splenial changes, reflecting immune-mediated CNS injury. Early neuroimaging is vital for proper diagnosis and better prognosis in affected children.