Kim Ji-hoon, Chang Kee-Hyun, Song In Chan, Kim Keon Ha, Kwon Bae Ju, Kim Hyo-Cheol, Kim Jae Hyoung, Han Moon Hee
Department of Radiology, Seoul National University College of Medicine, Korea.
AJNR Am J Neuroradiol. 2003 Sep;24(8):1592-7.
Carbon monoxide intoxication has delayed effects on the cerebral white matter characterized by bilateral, confluent lesions that reflect diffuse demyelination. To increase our understanding of this process, we assessed the diffusion characteristics of these lesions.
Five consecutive patients with delayed encephalopathy of CO intoxication were examined with diffusion MR imaging. Diffusion-weighted images (DWIs) were obtained 25-95 days after their exposure to CO and during a relapse of neuropsychiatric symptoms, which occurred after an initial recovery. Imaging was performed at 1.5 T by using a spin-echo echo-planar sequence with diffusion gradients of 0, 500, and 1000 s/mm(2). DWIs and apparent diffusion coefficient (ADC) maps were visually evaluated, and mean ADCs were calculated from the periventricular white matter and the centrum semiovale, where confluent hyperintensity was seen on T2-weighted images. Findings were compared with those of normal-looking white matter.
In all five patients, both T2-weighted images and DWIs showed the white matter lesions as bilateral, diffuse, confluent areas of hyperintensity in the periventricular white matter and centrum semiovale. On ADC maps, these lesions were isointense, with focal areas of hypointensity (n = 4) or diffuse hypointensity (n = 1). Mean ADC values of the white matter lesions were significantly lower than those of normal-looking white matter, regardless of their isointensity or hypointensity on ADC maps (P <.05).
Bilateral, confluent, white matter lesions in patients with delayed encephalopathy of CO intoxication show decreased diffusivity.
一氧化碳中毒对脑白质有延迟性影响，其特征为双侧融合性病变，反映弥漫性脱髓鞘。为增进我们对这一过程的理解，我们评估了这些病变的扩散特性。
对5例一氧化碳中毒后迟发性脑病患者连续进行扩散磁共振成像检查。在他们接触一氧化碳后25 - 95天以及最初恢复后出现神经精神症状复发期间，获取扩散加权图像（DWI）。成像在1.5T下进行，采用自旋回波平面回波序列，扩散梯度分别为0、500和1000s/mm²。对DWI和表观扩散系数（ADC）图进行视觉评估，并从脑室周围白质和半卵圆中心计算平均ADC值，这些区域在T2加权图像上可见融合性高信号。将结果与外观正常的白质进行比较。
所有5例患者的T2加权图像和DWI均显示脑室周围白质和半卵圆中心的白质病变为双侧、弥漫、融合性高信号区。在ADC图上，这些病变呈等信号，有局灶性低信号区（n = 4）或弥漫性低信号区（n = 1）。白质病变的平均ADC值显著低于外观正常的白质，无论其在ADC图上是等信号还是低信号（P <.05）。
一氧化碳中毒后迟发性脑病患者的双侧融合性白质病变显示扩散率降低。
