European Radiology

, Volume 29, Issue 3, pp 1375–1383 | Cite as

Early white matter injuries associated with dopamine transporter dysfunction in patients with acute CO intoxication: A diffusion kurtosis imaging and Tc-99m TRODAT-1 SPECT study

  • Ming-Chung Chou
  • Ping-Hong Lai
  • Jie-Yuan LiEmail author
Head and Neck



Patients with CO intoxication were demonstrated to exhibit white matter (WM) injuries, changes in substantia nigra, dopamine transporter dysfunctions of striatum and Parkinsonism symptoms. We aimed to investigate the relationship between WM injuries of dopaminergic pathways and dopamine transporter dysfunctions of the striatum in patients with acute CO intoxication using both diffusion kurtosis imaging (DKI) and single photon-emission computed tomography (SPECT).

Materials and methods

Seventeen patients with acute CO intoxication and 19 age- and gender-matched healthy subjects were enrolled. DKI data were acquired from all participants and Tc-99m-TRODAT-1 SPECT scan was performed on each patient. DKI datasets were fitted to obtain axial, radial and mean diffusivity, fractional anisotropy, axial, radial and mean kurtosis for voxel-based comparison. In addition, the TRODAT-1 binding ratio of the striatum was calculated using the occipital cortices as a reference. In significant regions, correlational analysis was performed to understand the relationship between DKI indices and TRODAT-1 binding ratio.


The results showed that DKI indices were significantly altered in multiple WM regions broadly involving the basal ganglia-thalamocortical circuit and nigrostriatal pathway. The correlation analysis further revealed significant correlations between DKI indices and the TRODAT-1 binding ratio in the nigrostriatal pathway (absolute correlation coefficients ranged from 0.5992 to 0.6950, p<0.05), suggesting that CO-induced early WM injuries were associated with dopamine transporter dysfunctions of striatum.


We concluded that DKI and Tc-99m-TRODAT-1 SPECT scans were helpful in early detection of global WM injuries associated with dysfunctions of dopamine transporter in patients with acute CO intoxication.

Key Points

• Voxel-based diffusion kurtosis imaging analysis was helpful in globally detecting early white matter injuries in patients with acute CO intoxication.

• CO-induced early white matter injuries were broadly located in basal ganglia-thalamocortical circuit and nigrostriatal pathway.

• Early white matter injuries in dopaminergic pathways were significantly correlated with dopamine transporter dysfunctions of the striatum.


Diffusion magnetic resonance imaging Carbon monoxide Dopamine transporter 



Anterior corona radiata


Axial diffusivity


Axial kurtosis


Brain extraction tool


Carbon monoxide




Cerebral peduncle;


Diffusion kurtosis estimator


Diffusion kurtosis imaging


Diffusion tensor imaging


Fractional anisotropy


FMRIB software library


Genu of corpus callosum


Globus pallidus


Hyperbaric oxygen therapy


Internal capsule


Inferior longitudinal fasciculus


Middle cerebellar peduncle


Mean diffusivity


Mean kurtosis


Posterior corona radiata


Posterior limb of internal capsule


Radial diffusivity


Radial kurtosis


Splenium of corpus callosum


Superior corona radiata


Superior longitudinal fasciculus


Single photon emission computed tomography


Statistical Parametric Mapping version 8


Sagittal stratum


Duration of coma


Time after onset


White matter



This study received funding by Dr. Ping-Hong Lai and Dr. Ming-Chung Chou from Ministry of Science and Technology (MOST) of Taiwan (106-2314-B-075B-002 -MY3 and 101-2314-B-037-047-MY2) and Dr. Jie‐Yuan Li from Veterans General Hospitals and University System of Taiwan Joint Research Program (VGHUST100‐G3‐2‐3).

Compliance with ethical standards


The scientific guarantor of this publication is Dr. Jie-Yuan Li.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.


• Prospective

• Case-control study

• Performed at one institution

Supplementary material

330_2018_5673_MOESM1_ESM.doc (164 kb)
ESM 1 (DOC 166 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Ming-Chung Chou
    • 1
    • 2
    • 3
  • Ping-Hong Lai
    • 4
    • 5
  • Jie-Yuan Li
    • 6
    • 7
    • 8
    Email author
  1. 1.Department of Medical Imaging and Radiological SciencesKaohsiung Medical UniversityKaohsiungTaiwan
  2. 2.Department of Healthcare Administration and Medical InformaticsKaohsiung Medical UniversityKaohsiungTaiwan
  3. 3.Department of Medical ResearchKaohsiung Medical University HospitalKaohsiungTaiwan
  4. 4.Department of RadiologyKaohsiung Veterans General HospitalKaohsiungTaiwan
  5. 5.Faculty of Medicine, School of MedicineNational Yang-Ming UniversityTaipeiTaiwan
  6. 6.Department of NeurologyE-Da HospitalKaohsiung CityTaiwan
  7. 7.School of MedicineI-Shou UniversityKaohsiungTaiwan
  8. 8.Department of NursingYuh-Ing Junior College of Health Care and ManagementKaohsiungTaiwan

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