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AJNR - American Journal of Neuroradiology

Published ahead of print on March 6, 2009
doi: 10.3174/ajnr.A1517

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American Journal of Neuroradiology 30:1248-1255, June-July 2009
© 2009 American Society of Neuroradiology

BRAIN

White Matter Damage in Carbon Monoxide Intoxication Assessed in Vivo Using Diffusion Tensor MR Imaging

W.-C. Lin^a,d, C.-H. Lu^b, Y.-C. Lee^f, H.-C. Wang^c, C.-C. Lui^a, Y.-F. Cheng^a, H.-W. Chang^g, Y.-T. Shih^a and C.-P. Lin^d,e

^a Departments of Diagnostic Radiology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
^b Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
^c Neurosurgery, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
^d Department of Biomedical Imaging and Radiological Sciences, Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan, Republic of China
^e Lab for Brain Connectivity, Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan, Republic of China
^f Department of Diagnostic Radiology, E-DA Hospital/I-Shou University, Kaohsiung, Taiwan, Republic of China
^g Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan, Republic of China

Please address correspondence to Ching-Po Lin, PhD, Department of Biomedical Imaging and Radiological Sciences, Institute of Neuroscience, National Yang-Ming University, 155 Li-Nong St, Sec 2, Peitou, Taipei, Taiwan, Republic of China; e-mail: cplin{at}ym.edu.tw

BACKGROUND AND PURPOSE: White matter (WM) injury in carbon monoxide (CO) intoxication is thought to be related to delayed cognitive sequelae. To determine if microstructural changes in WM are responsible for the delayed onset of cognitive symptoms, we performed diffusion tensor imaging (DTI) in patients with CO intoxication.

MATERIALS AND METHODS: DTI was performed in 14 patients with delayed sequelae after CO intoxication and in 16 sex- and age-matched healthy volunteers. The fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of several WM regions were measured. We also determined the correlation between FA of the selected WM and neuropsychological rating scores for the CO intoxication group.

RESULTS: FA of patients with CO intoxication decreased in the corpus callosum, orbitofrontal WM, high frontal WM, parietal WM, and temporal lobes in comparison with the corresponding regions of healthy controls. FA of the WM in the occipital lobe and internal capsule of patients was not significantly different from that in controls. ADCs of all measured WM increased significantly in patients exposed to CO. High correlations were found between the FA of all selected WM and the Mini-Mental State Examination score ( = 0.631, P = .016) and the digit span backward task ( = 0.759, P = .001).

CONCLUSIONS: CO intoxication may cause FA decline in associated cortical areas. This observation indicates microstructural WM pathology in CO intoxication, which is related to delayed cognitive encephalopathy.