Detecting damaged regions of cerebral white matter in the subacute phase after carbon monoxide poisoning using voxel-based analysis with diffusion tensor imaging

Fujiwara, Shunrou; Beppu, Teruhiko; Nishimoto, Hideaki; Sanjo, Katsumi; Koeda, Atsuhiko; Mori, Kiyoshi; Kudo, Kohsuke; Sasaki, Makoto; Ogasawara, Kuniaki

doi:10.1007/s00234-011-0958-8

Cited by 18 publications

(10 citation statements)

References 37 publications

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“…48,59 Our previous study in which we used DTI with voxelbased analysis also showed that deep WM areas including the centrum semiovale were the most widely damaged regions in those patients presenting with chronic symptoms (Fig 4). 60 When the CO-damaged brain is assessed by DWI or DTI, it is important to emphasize that evaluations of deep WM, including the centrum semiovale, are indispensable.…”

Section: 40mentioning

confidence: 99%

The Role of MR Imaging in Assessment of Brain Damage from Carbon Monoxide Poisoning: A Review of the Literature

Beppu

2013

American Journal of Neuroradiology

102

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SUMMARY:The aim of this article is to review how MR imaging and associated imaging modalities provide clinicopathologic information on brain damage after carbon monoxide poisoning. Initially, many authors documented typical findings of conventional MR imaging in the gray matter structures such as the globus pallidus and in various regions of cerebral white matter. The focus of investigation has since shifted to observation of cerebral white matter areas that are more frequently detected on MR imaging and are more responsible for chronic symptoms than the gray matter. DWI has dramatically contributed to the ability to quantitatively assess cerebral white matter damage. Subsequently, DTI has enabled more sensitive evaluation than DWI and can demonstrate progressive pathologic changes in the early stage, allowing prediction of chronic conditions. In addition, MR spectroscopy reveals changes in metabolite levels, offering quantitative clinicopathologic information on brain damage after carbon monoxide poisoning.ABBREVIATIONS: CO ϭ carbon monoxide; CWM ϭ cerebral white matter; DNS ϭ delayed neuropsychiatric sequelae; FA ϭ fractional anisotropy; GP ϭ globus

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Section: 40mentioning

confidence: 99%

The Role of MR Imaging in Assessment of Brain Damage from Carbon Monoxide Poisoning: A Review of the Literature

Beppu

2013

American Journal of Neuroradiology

102

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“…However, it is well known that the subacute phase is an important phase that indicates a risk of developing DNS in patients after CO exposure, and that WMD is highly associated with the occurrence of DNS9101219. Therefore, we hypothesized that BT is associated with WMD in patients with CO-poisoning.…”

Section: Discussionmentioning

confidence: 97%

“…On the other hand, patients who presented delayed neuropsychiatric sequelae (DNS) showed remarkable BT reduction of >1 °C between the acute and subacute phases. It has been well known that the occurrence of DNS was highly associated with cerebral white matter damage (WMD) caused by progressive demyelination after CO inhalation910111213; thus, BT in patients with CO-poisoning may potentially be associated with the degree of WMD, which can affect brain metabolism. Thus, the aim of the present study was to investigate whether the BT in patients with CO-poisoning was associated with the degree of WMD in the subacute phase.…”

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confidence: 99%

Relation between brain temperature and white matter damage in subacute carbon monoxide poisoning

Fujiwara

Yoshioka

Matsuda³

et al. 2016

Sci Rep

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In the previous studies, carbon monoxide (CO) poisoning showed an imbalance between cerebral perfusion and metabolism in the acute phase and the brain temperature (BT) in these patients remained abnormally high from the acute to the subacute phase. As observed in chronic ischemic patients, BT can continuously remain high depending on impairments of cerebral blood flow and metabolism; this is because heat removal and production system in the brain may mainly be maintained by the balance of these two factors; thus, cerebral white matter damage (WMD) affecting normal metabolism may affect the BT in patients with CO poisoning. Here, we investigated whether the BT correlates with the degree of WMD in patients with subacute CO-poisoning. In 16 patients with subacute CO-poisoning, the BT and degree of WMD were quantitatively measured by using magnetic resonance spectroscopy and the fractional anisotropy (FA) value from diffusion tensor imaging dataset. Consequently, the BT significantly correlated with the degree of WMD. In particular, BT observed in patients with delayed neuropsychiatric sequelae, a crucial symptom with sudden-onset in the chronic phase after CO exposure, might indicate cerebral hypo-metabolism and abnormal hemodynamics like “matched perfusion,” in which the reduced perfusion matches the reduced metabolism.

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“…Indeed, some studies have reported correlations between FA values in various regions of the CWM in the chronic phase and cognitive dysfunction among CO-poisoned patients with DNS [16, 23, 30]. However, the centrum semiovale in the CWM has been suggested as a key region responsible for chronic neurological symptoms [4, 10, 19, 22]. A study using DTI at various phases after CO poisoning has also shown that FA in the centrum semiovale changes in parallel with cognitive impairments or neurological symptoms [17].…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, FA is frequently used for evaluating the extent of damaged CWM fibers in patients with demyelinating diseases such as multiple sclerosis [1, 27]. CO poisoning causes damage in various regions of the CWM, but the centrum semiovale has been considered a region more responsible for chronic neuropsychiatric symptoms after CO poisoning than other regions [4, 10, 19, 22]. Herein, we measured FA from DTI at the centrum semiovale in CO-poisoned patients, and evaluated the correlation between the FA and concentration of MBP in the CSF.…”

Section: Introductionmentioning

confidence: 99%

Fractional anisotropy in the centrum semiovale as a quantitative indicator of cerebral white matter damage in the subacute phase in patients with carbon monoxide poisoning: correlation with the concentration of myelin basic protein in cerebrospinal fluid

et al. 2012

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Carbon monoxide (CO) poisoning leads to demyelination of cerebral white matter (CWM) fibers, causing chronic neuropsychiatric symptoms. To clarify whether fractional anisotropy (FA) from diffusion tensor imaging in the centrum semiovale can depict demyelination in the CWM during the subacute phase after CO inhalation, we examined correlations between FA in the centrum semiovale and myelin basic protein (MBP) in cerebrospinal fluid. Subjects comprised 26 adult CO-poisoned patients ≤60 years old. MBP concentration was examined for all patients at 2 weeks after CO inhalation. The mean FA of the centrum semiovale bilaterally at 2 weeks was also examined for all patients and 21 age-matched healthy volunteers as controls. After these examinations, the presence of chronic symptoms was checked at 6 weeks after CO poisoning. Seven patients displayed chronic symptoms, of whom six showed abnormal MBP concentrations. The remaining 19 patients presented no chronic symptoms and no abnormal MBP concentrations, with MBP concentrations undetectable in 16 patients. The MBP concentration differed significantly between patients with and without chronic symptoms. The mean FA was significantly lower in patients displaying chronic symptoms than in either patients without chronic symptoms or controls. After excluding the 16 patients with undetectable MBP concentrations, a significant correlation was identified between MBP concentration and FA in ten patients. The present results suggest that FA in the centrum semiovale offers a quantitative indicator of the extent of demyelination in damaged CWM during the subacute phase in CO-poisoned patients.

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Detecting damaged regions of cerebral white matter in the subacute phase after carbon monoxide poisoning using voxel-based analysis with diffusion tensor imaging

Abstract: VBA demonstrated that CO-poisoned patients with chronic neurological symptoms had already suffered damage to various CWM regions in the subacute phase. In these regions, the centrum semiovale was suggested to be the main region damaged in the subacute phase after CO inhalation.

Cited by 18 publications

References 37 publications

The Role of MR Imaging in Assessment of Brain Damage from Carbon Monoxide Poisoning: A Review of the Literature

The Role of MR Imaging in Assessment of Brain Damage from Carbon Monoxide Poisoning: A Review of the Literature

Relation between brain temperature and white matter damage in subacute carbon monoxide poisoning

Fractional anisotropy in the centrum semiovale as a quantitative indicator of cerebral white matter damage in the subacute phase in patients with carbon monoxide poisoning: correlation with the concentration of myelin basic protein in cerebrospinal fluid

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