Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan.
Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan.
Eur Radiol. 2019 Mar;29(3):1375-1383. doi: 10.1007/s00330-018-5673-y. Epub 2018 Aug 24.
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).
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.
• 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.
有研究表明，一氧化碳（CO）中毒患者存在脑白质（WM）损伤、黑质改变、纹状体多巴胺转运体功能障碍和帕金森病症状。本研究旨在通过扩散峰度成像（DKI）和单光子发射计算机断层扫描（SPECT），研究急性 CO 中毒患者的 WM 损伤与纹状体多巴胺转运体功能障碍之间的关系。
共纳入 17 例急性 CO 中毒患者和 19 名年龄和性别匹配的健康对照者。所有参与者均行 DKI 检查，17 例患者行 Tc-99m-TRODAT-1 SPECT 扫描。对 DKI 数据进行拟合，以获得基于体素的比较的轴向、径向和平均扩散系数、各向异性分数、轴向、径向和平均峰度。另外，以枕叶皮质为参照，计算纹状体的 TRODAT-1 结合率。在有统计学意义的区域，行相关性分析以了解 DKI 指标与 TRODAT-1 结合率之间的关系。
结果显示，多个 WM 区域的 DKI 指标广泛改变，这些区域主要涉及基底节-丘脑皮质回路和黑质纹状体通路。相关性分析进一步显示，黑质纹状体通路的 DKI 指数与 TRODAT-1 结合率之间存在显著相关性（绝对相关系数范围为 0.5992 至 0.6950，p<0.05），表明 CO 诱导的早期 WM 损伤与纹状体多巴胺转运体功能障碍有关。
我们的研究表明，DKI 和 Tc-99m-TRODAT-1 SPECT 扫描有助于早期发现急性 CO 中毒患者与多巴胺转运体功能障碍相关的全脑 WM 损伤。
• 基于体素的扩散峰度成像分析有助于全面检测急性 CO 中毒患者的早期 WM 损伤。
• CO 诱导的早期 WM 损伤广泛位于基底节-丘脑皮质回路和黑质纹状体通路。
• 多巴胺能通路的早期 WM 损伤与纹状体多巴胺转运体功能障碍显著相关。
