Delayed Parkinsonism after CO Intoxication: Evaluation of the Substantia Nigra with Inversion-Recovery MR Imaging |
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Authors: | Hung-Wen Kao Nai-Yu Cho Chun-Jen Hsueh Ming-Chung Chou Hsiao-Wen Chung Michelle Liou Shih-Wei Chiang Shao-Yuan Chen Chun-Jung Juan Guo-Shu Huang Cheng-Yu Chen |
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Affiliation: | Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, 325, Section 2, Cheng-Kung Rd., Neihu, Taipei 114, Taiwan, Republic of China; Institute of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan; Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan; Institute of Statistical Science, Academia Sinica, Taipei, Taiwan; Department of Hyperbaric Medicine and Neurology, Cardinal Tien Hospital, Taipei, Taiwan. |
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Abstract: | Purpose: To quantitatively investigate signal alterations of the substantia nigra in patients with delayed parkinsonism following CO intoxication, as seen on gray matter (GM)-suppressed inversion-recovery (IR) magnetic resonance (MR) images. Materials and Methods: This prospective study was approved by the local institutional review board, and written informed consent was obtained from all subjects. Thirteen patients with delayed onset of CO-induced parkinsonism (nine men and four women; mean age, 40.3 years), 13 age-matched CO-intoxicated patients without parkinsonism, and 13 age-matched healthy volunteers were examined with GM-suppressed IR MR imaging. The signal intensity of the substantia nigra was normalized to the adjacent normal-appearing white matter in the temporal lobe, followed by semiautomatic segmentation into medial, middle, and lateral parts by using a skeleton-based algorithm. Multivariate and univariate analyses and Spearman rank correlation test were performed to examine the relationships between variables. Clinical severity was assessed with the modified Hoehn and Yahr rating scale. Results: The normalized signal ratios in the middle and lateral segments of the substantia nigra were significantly higher in those with CO-induced parkinsonism, compared with those with CO intoxication without parkinsonism or normal volunteers (P = .02). For the medial segments, the ratios showed no significant differences among the groups. The normalized signal ratios of substantia nigra were correlated with the severity of parkinsonism, particularly in the lateral segments (ρ = 0.927, P < .001). Conclusion: CO toxicity to the substantia nigra plays a role in pathophysiologic mechanisms of CO-induced parkinsonism. GM-suppressed IR MR imaging is a useful tool in depicting substantia nigra injury following CO intoxication. ? RSNA, 2012. |
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