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Preliminary Assessment of Intravoxel Incoherent Motion Diffusion-Weighted MRI Metrics in Acute Carbon Monoxide Poisoning1Yan 'an People's Hospital, Yan 'an, China, 2First Affiliated Hospital of Xi 'an Jiaotong University, Xi 'an, China
Synopsis
The purpuse of this study was to assess microvascular perfusion and microstructural integrity using Intravoxel incoherent motion (IVIM) imaging in patients with acute CO poisoning.Thirteen patients with acute CO poisoning and 15 healthy subjects were enrolled. IVIM MRI was collected using a 3.0-T scanner.The ROIs analysis was perforemed. The IVIM perfusion fraction was significantly reduced in multiple brain regions and IVIM diffusion metirc was significantly decreased in centrum semiovale and multiple subcortical gray matter nucleis in CO poisoning. This study shows that IVIM-DWI may be a promising method to assess brain perfusion and injury in acute CO poisoning.
INTRODUCTION
Carbon monoxide (CO) poisoning is one of the most usual kinds of poisoning worldwide.1,2 CO might harm numerous organ systems, particularly systems with high oxygen usage such as the central nervous system (CNS).1 Acute CO poisoning can lead to diverse symptoms, from headache, chest pain, dyspnea, and mental confusion, to coma or death.3,4Magnetic resonance imaging(MRI) is an easily accessible, minimally invasive procedure for the objective evaluation of brain injury of CO poisoning.5 Diffusion tensor imaging and diffusion kurtosis imaging studies found reduced microstructural integrity of the white matter and damage of subcortical gray matter nuclei in patients with CO poisoning compared with healthy controls.6-9 In addition to microstructural changes, several research studies revealed decreased cerebral perfusion in patients with CO poisoning.10-12 Most of these studies examined perfusion differences by single-photon emission computed tomography (SPECT) methods. However, studies that evaluated both diffusion and perfusion in patients with CO poisoning are scarce.
Intravoxel incoherent motion (IVIM) imaging is a diffusion-weighted magnetic resonance imaging (MRI) method with multiple b values developed to identify microvascular perfusion and microstructural integrity concurrently.13,14 IVIM allows quantification of three parameters, which are D, D*, and f, with a biexponential fit. D indicates the pure diffusion coefficient, which can reflect microstructural integrity. D* represents the pseudodiffusion coefficient, and f is a surrogate for microvascular perfusion.13,15 This technique has formerly been used in the brain to characterize perfusion and diffusion of Alzheimer's Disease,16 as well as cerebral ischemia.17,18 According to our literature review, no research with IVIM has been applied to the study of CO poisoning.
Therefore, the purpose of this study was to assess microvascular perfusion and microstructural integrity using IVIM MRI in patients with acute CO poisoning.
METHODS
Thirteen patients with acute CO poisoning were included from the Yan 'an People's Hospital, Shan Xi province, China. All of them were received MRI between 2 and 10 days after CO poisoning. Patients satisfying the following diagnostic criteria were chosen: a clear history of recent CO exposure; age ≥ 20 years; there was no traumatic brain injury, cerebral hemorrhage, cerebral infarction, or other intracranial lesions. Meanwhile, 15 healthy subjects were enrolled as controls for the study. All study protocols were approved by the Ethics Committee at Yan'an People's Hospital, and all participants or family members gave written informed consent before study inclusion.MRI was performed using a 3.0-T scanner (Siemens Prisma, Erlangen, Germany) with a twenty-four channel head coil. MRI sequences included T1-weighted image (T1WI), T2WI, and IVIM-DWI. IVIM-DWI was performed using eight b-values (50, 100,150, 200, 400, 600, 800, and 1000 s/mm2 with the following acquisition parameters: repetition time 3,700 ms, echo time 80 ms, field of view 256 × 256 mm2, acquisition matrix 128 × 128, slice thickness 5 mm. Image analysis was performed automatically by the workstation (Advantage Workstation, Siemens Healthcare). Maps of D, D*, f were obtained.
The ROIs analysis on the parametric maps was performed by two radiologists. According to previous literature, ten ROIs were chosen, which were the globus pallidus (GP), caudate nucleus, thalamus, hippocampus, centrum semiovale (CS), periventricular, corpus callosum (CC), frontal lobe, occipital lobe, temporal lobe, and parietal lobe. Except for the CC genu, body, and splenium, other ROIs were placed bilaterally, and the mean value was extracted.
Statistical analysis was performed using SPSS 20. A normality test (Kolmogorov-Smirnov) and homogeneity of variance test (Levene’s test) were performed. Between-group differences were analyzed using analysis of covariance (ANCOVA), controlling for age and sex.
RESULTS
The subject demographics and clinical information are shown in Table 1.As shown in Table 2 and Figure 1, IVIM f was significantly decreased in patients with acute CO poisoning in globus pallidus, thalamus, centrum semiovale, periventricular, parietal lobe, frontal lobe. In the acute CO poisoning, IVIM D was significantly lower in globus pallidus, caudate nucleus, thalamus, and centrum semiovale compared to the HC.
DISCUSSION
In the present study, we found that the IVIM perfusion fraction was significantly reduced in multiple gray matter cortical regions, subcortical white matter regions, and subcortical gray matter nuclei in patients with acute CO poisoning. Meanwhile, we revealed that the IVIM diffusion metric was significantly decreased mainly in centrum semiovale and multiple subcortical gray matter nuclei in CO poisoning.In patients with acute CO poisoning, the lower IVIM perfusion indices in the globus pallidus and thalamus were in parallel with the higher IVIM diffusion metrics. A higher D indicates less restricted water diffusion, which is a surrogate for decreased microstructural integrity. A higher f* is a surrogate for higher microvascular perfusion.13-15 This indicates the vulnerability of this particular brain region in CO poisoning. The predilection of globus pallidus and thalamus involvement in CO poisoning has been frequently reported in MRI analysis and SPECT research.7,9,11,12,19 The reasons for selective damage to globus pallidus may be that this region is easily affected by the hypoxic-hypotension process because of a poor anastomotic blood supply.5,20 The additional affected regions from our IVIM analysis suggested hypoperfusion in occipital, temporal, and frontal regions. This is consistent with previous SPECT studies.10-12
CONCLUSION
This study shows that IVIM-DWI may be a promising method to quantitatively assess brain perfusion and brain injury in acute CO poisoning.Acknowledgements
No acknowledgement found.References
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