Longitudinal study of carbon monoxide intoxication by diffusion tensor imaging with neuropsychiatric correlation

Longitudinal study of carbon monoxide intoxication by diffusion tensor imaging with neuropsychiatric correlation


J Psychiatry Neurosci 2010;35(2):115-125

Chiung-Chih Chang, MD; Wen-Neng Chang, MD; Chun-Chung Lui, MD; Jiun-Jie Wang, PhD; Chih-Feng Chen, MD; Yu-Chang Lee, MD; Shun-Sheng Chen, MD, PhD; Yu-Ting Lin, BS; Chi-Wei Huang, MD; Ching Chen, MPsych

C.-C. Chang, W.-N. Chang, S.-S. Chen, Lin, Huang — Department of Neurology; Lui, C.-F. Chen, Lee — Department of Radiology; C. Chen — Department of Psychiatry, Chang Gung Memorial Hospital, Kaohsiung Medical Center and ChangGung University College of Medicine; Wang — Department of Medical Imaging and Radiological Sciences, Chang Gung Uni-versity and Magnetic Resonance Imaging Centre, Chang Gung Memorial Hospital; Lee — Department of Radiology, I-ShouUniversity Hospital, Kaohsiung, Taiwan


Background: White matter damage is common after carbon monoxide (CO) intoxication, but in vivo follow-up studies about the mechanism of white matter damage are not possible in pathology series. Diffusion tensor imaging (DTI) and voxel-based morphometry (VBM) can quantify diffusion parameters and volumetric changes in white matter that can be correlated with neuropsychological performances in longitudinal studies.

Methods: We examined 9 patients with CO intoxication using DTI, VBM and neuropsychologic tests at an average of 3 and 10 months after CO exposure. We used data from 18 age- and sex-matched controls for comparison.

Results: We found that cognitive recovery at 10 months after CO intoxication was not significant, although it was after 3 months. The neuropsychologic tests correlated better for the fibre tract of the semicentrum ovale and not the periventricular fibres. Diffusion measures suggest increases in fractional anisotropy, mean diffusivity and axial eigenvalues over time, while increases in radial eigenvalue were evident at 3 months compared with controls. Periventricular white matter atrophy was observed 10 months after CO intoxication.

Limitations: Our study in-cluded few cases, and the interpretation of the putative changes on neuroimaging findings cannot be confirmed by histology.

Conclusion: Our study showed that the evolution of white matter injury in CO encephalopathy occurred over time. Cognitive recovery was notevident in the follow-up period because of white matter injuries.

Submitted May 12, 2009; Revised Sept. 14, Nov. 2, 2009; Accepted Nov. 3, 2009.

Acknowledgments: The authors thank Dr. C.F. Jiang, I-Shou University, for support with DTI acquisition and analyses, and Dr. C.W. Chiang, Kaohsiung Naval General Hospital, for referring patients with CO intoxication. This work was supported in part by grant CMRPG860171 from the Chang Gung Memorial Hospital.

Competing interests: Dr. Wang has received speakers fees from Johnson & Johnson, Taiwan. None declared for all other authors.

Contributors: Drs. C.-C. Chang, W.-N. Chang and S.-S. Chen designed the study. Drs. C.-C. Chang, Lui, C.-F. Chen, Lee, S.-S. Chen, Lin, Huang and C. Chen acquired the data, which Drs. C.-C. Chang, Wang and S.-S. Chen analyzed. Drs. C.-C. Chang, Lui and Wang wrote the article. Drs. W.-N. Chang, Lui, Wang, C.-F. Chen, Lee, S.-S. Chen, Lin, Huang and C. Chen reviewed it. All authors approved the article’s final publication.

DOI: 10.1503/jpn.090057

Correspondence to: Dr. C.-C. Chang, Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Rd., Niaosung, Kaohsiung County 833, Taiwan; fax 886-7-731-7123 ext. 3390; neur099@adm.cgmh.org.tw