Delayed Encephalopathy of Acute Carbon Monoxide Intoxication: Diffusivity of Cerebral White Matter Lesions
Ji-hoon Kima,
Kee-Hyun Changa,b,c,
In Chan Songa,b,
Keon Ha Kima,
Bae Ju Kwona,
Hyo-Cheol Kima,
Jae Hyoung Kima and
Moon Hee Hana,b,c
a Department of Radiology, Seoul National University College of Medicine, Korea
b Institute of Radiation Medicine, Seoul National University College of Medicine, Korea
c Neuroscience Research Institute, Seoul National University College of Medicine, Korea
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FIG 1. Case 1. MR images obtained in a 54-year-old woman on day 25 after CO exposure.
A and B, T2-weighted images (TR/TE/NEX, 4000/98/1) show bilateral, symmetric, confluent areas of high signal intensity in both the centrum semiovale (A) and periventricular white matter (B). The high intensity appears more prominent in the frontal lobes than elsewhere.
C and D, ADC maps (calculated from DWIs [6500/98/1, b = 0 and 1000 s/mm2]) obtained at the same levels as in A and B, respectively, show focal areas of low signal intensity (decreased diffusion) in the bilateral frontal lobes. Most of the remaining centrum semiovale and periventricular white matter appears isointense. DWIs at the same levels showed confluent high signal intensity in the centrum semiovale and periventricular white matter. The appearance was similar to that on the T2-weighted images (not shown) and mainly resulted from a T2 shine-through effect.
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FIG 2. Case 2. MR images obtained in a 71- year-old man on day 41 after CO exposure.
A, FLAIR image (TR/TE/TI/NEX, 9000/110/2200/1) shows asymmetric distribution of the high-intensity lesions in the periventricular white matter and corpus callosum.
B, DWI (TR/TE/NEX, 6500/98/1; b = 1000 s/mm2) shows similar high signal intensity in the periventricular white matter and corpus callosum. The high intensity is more prominent in the right frontal lobe and on the right side of the genu of the corpus callosum than elsewhere.
C, ADC map shows a focal area of subtle low signal intensity in the right frontal lobe (arrow). Other white matter lesions appear isointense.
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FIG 3. Case 4. MR images obtained in a 65-year-old woman on day 55 after CO exposure.
A, FLAIR image (TR/TE/TI/NEX, 9000/110/2200/1) shows diffuse high-intensity lesions in the periventricular white matter.
B, DWI (TR/TE/NEX, 6500/98/1; b = 1000 s/mm2) shows confluent high signal intensity in the same periventricular white matter.
C, ADC map shows diffuse low signal intensity in the periventricular white matter.
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