, Volume 54, Issue 7, pp 681–689 | Cite as

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

  • Shunrou Fujiwara
  • Takaaki BeppuEmail author
  • Hideaki Nishimoto
  • Katsumi Sanjo
  • Atsuhiko Koeda
  • Kiyoshi Mori
  • Kohsuke Kudo
  • Makoto Sasaki
  • Kuniaki Ogasawara
Diagnostic Neuroradiology



The present study aimed to detect the main regions of cerebral white matter (CWM) showing damage in the subacute phase for CO-poisoned patients with chronic neurological symptoms using voxel-based analysis (VBA) with diffusion tensor imaging (DTI).


Subjects comprised 22 adult CO-poisoned patients and 16 age-matched healthy volunteers as controls. Patients were classified into patients with transient acute symptoms only (group A) and patients with chronic neurological symptoms (group S). In all patients, DTI covering the whole brain was performed with a 3.0-T magnetic resonance imaging system at 2 weeks after CO exposure. As procedures for VBA, all fractional anisotropy (FA) maps obtained from DTI were spatially normalized, and FA values for all voxels in the whole CWM on normalized FA maps were statistically compared among the two patient groups and controls.


Voxels with significant differences in FA were detected at various regions in comparisons between groups S and A and between group S and controls. In these comparisons, more voxels were detected in deep CWM, including the centrum semiovale, than in other regions. A few voxels were detected between group A and controls. Absolute FA values in the centrum semiovale were significantly lower in group S than in group A or controls.


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.


CO poisoning Diffusion tensor imaging Fractional anisotropy Myelin basic protein Voxel-based analysis 



This study was supported in part by Grant-in-Aid for Scientific Research C (no. 22592020) and grants for the Strategic Medical Science Research Center for Advanced Medical Science Research from the Ministry of Science, Education, Sports and Culture, Japan.

Conflict of interest

We declare that we have no conflict of interest.


  1. 1.
    Weaver LK, Hopkins RO, Elliott G (1999) Carbon monoxide poisoning. N Engl J Med 340:1290PubMedCrossRefGoogle Scholar
  2. 2.
    Choi IS (1983) Delayed neurologic sequelae in carbon monoxide intoxication. Arch Neurol 40:433–435PubMedCrossRefGoogle Scholar
  3. 3.
    Thom SR (1990) Carbon monoxide-mediated brain lipid peroxidation in the rat. J Appl Physiol 68:997–1003PubMedGoogle Scholar
  4. 4.
    Thom SR, Bhopale VM, Fisher D et al (2004) Delayed neuropathology after carbon monoxide poisoning is immune-mediated. Proc Natl Acad Sci USA 101:13660–13665PubMedCrossRefGoogle Scholar
  5. 5.
    Weaver LK (2009) Clinical practice. Carbon monoxide poisoning. N Engl J Med 360:1217–1225PubMedCrossRefGoogle Scholar
  6. 6.
    Hopkins RO, Fearing MA, Weaver LK et al (2006) Basal ganglia lesions following carbon monoxide poisoning. Brain Inj 20:273–281PubMedCrossRefGoogle Scholar
  7. 7.
    Tuchman RF, Moser FG, Moshe SL (1990) Carbon monoxide poisoning: bilateral lesions in the thalamus on MR imaging of the brain. Pediatr Radiol 20:478–479PubMedCrossRefGoogle Scholar
  8. 8.
    Kawanami T, Kato T, Kurita K et al (1998) The pallidoreticular pattern of brain damage on MRI in a patient with carbon monoxide poisoning. J Neurol Neurosurg Psychiatry 64:282PubMedCrossRefGoogle Scholar
  9. 9.
    Prockop LD (2005) Carbon monoxide brain toxicity: clinical, magnetic resonance imaging, magnetic resonance spectroscopy, and neuropsychological effects in 9 people. J Neuroimaging 15:144–149PubMedGoogle Scholar
  10. 10.
    Parkinson RB, Hopkins RO, Cleavinger HB et al (2002) White matter hyperintensities and neuropsychological outcome following carbon monoxide poisoning. Neurology 58:1525–1532PubMedCrossRefGoogle Scholar
  11. 11.
    Mascalchi M, Petruzzi P, Zampa V (1996) MRI of cerebellar white matter damage due to carbon monoxide poisoning: case report. Neuroradiology 38:73–74CrossRefGoogle Scholar
  12. 12.
    O’Donnell P, Buxton PJ, Pitkin A et al (2000) The magnetic resonance imaging appearances of the brain in acute carbon monoxide poisoning. Clin Radiol 55:273–280PubMedCrossRefGoogle Scholar
  13. 13.
    Kim JH, Chang KH, Song IC et al (2003) Delayed encephalopathy of acute carbon monoxide intoxication: diffusivity of cerebral white matter lesions. AJNR Am J Neuroradiol 24:1592–1597PubMedGoogle Scholar
  14. 14.
    Lin WC, Lu CH, Lee YC et al (2009) White matter damage in carbon monoxide intoxication assessed in vivo using diffusion tensor MR imaging. AJNR Am J Neuroradiol 30:1248–1555PubMedCrossRefGoogle Scholar
  15. 15.
    O’Sullivan M, Morris RG, Huckstep B et al (2004) Diffusion tensor MRI correlates with executive dysfunction in patients with ischaemic leukoaraiosis. J Neurol Neurosurg Psychiatry 75:441–447PubMedCrossRefGoogle Scholar
  16. 16.
    Le Bihan D, Mangin JF, Poupon C et al (2001) Diffusion tensor imaging: concepts and applications. J Magn Reson Imaging 13:534–546PubMedCrossRefGoogle Scholar
  17. 17.
    Beaulieu C (2002) The basis of anisotropic water diffusion in the nervous system: a technical review. NMR Biomed 15:435–455PubMedCrossRefGoogle Scholar
  18. 18.
    Bammer R, Augustin M, Strasser-Fuchs S et al (2000) Magnetic resonance diffusion tensor imaging for characterizing diffuse and focal white matter abnormalities in multiple sclerosis. Magn Reson Med 44:583–591PubMedCrossRefGoogle Scholar
  19. 19.
    Tievsky AL, Ptak T, Farkas J (1999) Investigation of apparent diffusion coefficient and diffusion tensor anisotropy in acute and chronic multiple sclerosis lesions. AJNR Am J Neuroradiol 20:1491–1499PubMedGoogle Scholar
  20. 20.
    Vila JF, Meli FJ, Serqueira OE et al (2005) Diffusion tensor magnetic resonance imaging: a promising technique to characterize and track delayed encephalopathy after acute carbon monoxide poisoning. Undersea Hyperb Med 32:151–156PubMedGoogle Scholar
  21. 21.
    Terajima K, Igarashi H, Hirose M et al (2008) Serial assessments of delayed encephalopathy after carbon monoxide poisoning using magnetic resonance spectroscopy and diffusion tensor imaging on 3.0 T system. Eur Neurol 59:55–61PubMedCrossRefGoogle Scholar
  22. 22.
    Wright IC, McGuire PK, Poline JB et al (1995) A voxel-based method for the statistical analysis of gray and white matter density applied to schizophrenia. NeuroImage 2:244–252PubMedCrossRefGoogle Scholar
  23. 23.
    Folstein MF, Folstein SE, McHugh PR (1975) Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198PubMedCrossRefGoogle Scholar
  24. 24.
    Rorden C, Brett M (2000) Stereotaxic display of brain lesions. Behav Neurol 12:191–200PubMedGoogle Scholar
  25. 25.
    Schiavone F, Charlton RA, Barrick TR et al (2009) Imaging age-related cognitive decline: a comparison of diffusion tensor and magnetization transfer MRI. J Magn Reson Imaging 29:23–30PubMedCrossRefGoogle Scholar
  26. 26.
    Wright SP (1992) Adjusted p-values for simultaneous inference. Biometrics 48:1005–1013CrossRefGoogle Scholar
  27. 27.
    Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86:420–428PubMedCrossRefGoogle Scholar
  28. 28.
    Ide T, Kamijo Y (2008) Myelin basic protein in cerebrospinal fluid: a predictive marker of delayed encephalopathy from carbon monoxide poisoning. Am J Emerg Med 26:908–912PubMedCrossRefGoogle Scholar
  29. 29.
    Beppu T, Nishimoto H, Ishigaki D et al (2010) Assessment of damage to cerebral white matter fiber in the subacute phase after carbon monoxide poisoning using fractional anisotropy in diffusion tensor imaging. Neuroradiology 52:735–743PubMedCrossRefGoogle Scholar
  30. 30.
    Kado H, Kimura H, Murata T et al (2004) Carbon monoxide poisoning: two cases of assessment by magnetization transfer ratios and 1H-MRS for brain damage. Radiat Med 22:190–194PubMedGoogle Scholar
  31. 31.
    Jain KK (2009) Carbon monoxide and other tissue poisons. In: Jain KK (ed) Textbook of hyperbaric medicine, 5th edn. Hogrefe and Huber, Cambridge, pp 43–133Google Scholar
  32. 32.
    Chang KH, Han MH, Kim HS et al (1992) Delayed encephalopathy after acute carbon monoxide intoxication: MR imaging features and distribution of cerebral white matter lesions. Radiology 184:117–122PubMedGoogle Scholar
  33. 33.
    Sohn YH, Jeong Y, Kim HS et al (2000) The brain lesion responsible for parkinsonism after carbon monoxide poisoning. Arch Neurol 57:1214–1218PubMedCrossRefGoogle Scholar
  34. 34.
    Lo CP, Chen SY, Chou MC et al (2007) Diffusion-tensor MR imaging for evaluation of the efficacy of hyperbaric oxygen therapy in patients with delayed neuropsychiatric syndrome caused by carbon monoxide inhalation. Eur J Neurol 14:777–782PubMedCrossRefGoogle Scholar
  35. 35.
    Beppu T, Nishimoto H, Fujiwara S, et al (2011) 1H-magnetic resonance spectroscopy indicates damage to cerebral white matter in the subacute phase after CO poisoning. J Neurol Neurosurg Psychiatry (in press)Google Scholar
  36. 36.
    Chang CC, Chang WN, Lui CC et al (2010) Longitudinal study of carbon monoxide intoxication by diffusion tensor imaging with neuropsychiatric correlation. J Psychiatry Neurosci 35:115–125PubMedCrossRefGoogle Scholar
  37. 37.
    Chang CC, Lee YC, Chang WN et al (2009) Damage of white matter tract correlated with neuropsychological deficits in carbon monoxide intoxication after hyperbaric oxygen therapy. J Neurotrauma 26:1263–1270PubMedCrossRefGoogle Scholar
  38. 38.
    Charlton RA, Barrick TR, McIntyre DJ et al (2006) White matter damage on diffusion tensor imaging correlates with age-related cognitive decline. Neurology 66:217–222PubMedCrossRefGoogle Scholar
  39. 39.
    Salat DH, Tuch DS, Greve DN et al (2005) Age-related alterations in white matter microstructure measured by diffusion tensor imaging. Neurobiol Aging 26:1215–1227PubMedCrossRefGoogle Scholar
  40. 40.
    Kennedy MR, Wozniak JR, Muetzel RL et al (2009) White matter and neurocognitive changes in adults with chronic traumatic brain injury. J Int Neuropsychol Soc 15:130–136PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Shunrou Fujiwara
    • 1
  • Takaaki Beppu
    • 1
    • 2
    Email author
  • Hideaki Nishimoto
    • 1
  • Katsumi Sanjo
    • 3
  • Atsuhiko Koeda
    • 3
  • Kiyoshi Mori
    • 4
  • Kohsuke Kudo
    • 5
  • Makoto Sasaki
    • 5
  • Kuniaki Ogasawara
    • 1
  1. 1.Department of NeurosurgeryIwate Medical UniversityMoriokaJapan
  2. 2.Department of Hyperbaric MedicineIwate Medical UniversityMoriokaJapan
  3. 3.Department of PsychiatryIwate Medical UniversityMoriokaJapan
  4. 4.Department of NeurologyIwate Prefectural Critical Care and Emergency CenterMoriokaJapan
  5. 5.Advanced Medical Research CenterIwate Medical UniversityMoriokaJapan

Personalised recommendations