This chapter examines the neurometabolic and structural changes in Long COVID through advanced neuroimaging techniques, with a particular focus on FDG-PET and MRI findings. Through detailed analysis of recent research, the text presents evidence of distinctive patterns of brain glucose metabolism in Long COVID patients, highlighting significant hypometabolism in key regions including the olfactory system, limbic regions, and brainstem. The chapter introduces the concept of metabolic heterogeneity as a potential protective mechanism against fatigue symptoms, supported by quantitative analysis showing differences between fatigued and non-fatigued individuals. Special attention is given to basal ganglia dysfunction, where multiple imaging approaches have revealed persistent neurological disruption through both metabolic and structural changes. The text includes comparative studies with other neurological conditions, particularly multiple sclerosis, providing context for understanding the specificity of Long COVID-related brain changes. Through five detailed figures, the chapter illustrates these findings, including 3D renderings of hypometabolism patterns, representative FDG-PET brain images, comparative metabolic studies, and anatomical MRI scans showing structural changes in the basal ganglia. This comprehensive analysis of neuroimaging findings provides crucial insights into the neurobiological basis of Long COVID fatigue and its potential mechanisms.