Journal List > Investig Magn Reson Imaging > v.23(3) > 1135553

Lee, Hwang, Bae, Park, Goo, and Park: An MRI-Based Quantification for Correlation of Imaging Biomarker and Clinical Performance in Chronic Phase of Carbon Monoxide Poisoning

Abstract

Purpose

The purpose of this study was to determine the relation between quantitative magnetic resonance imaging biomarkers, and clinical performances in chronic phase of carbon monoxide intoxication.

Materials and Methods

Eighteen magnetic resonance scans and cognitive evaluations were performed, on patients with carbon monoxide intoxication in chronic phase. Apparent diffusion coefficient (ADC) ratios of affected versus unaffected centrum semiovale, and corpus callosum were obtained. Signal intensity (SI) ratios between affected centrum semiovale, and normal pons in T2-FLAIR (fluid-attenuated inversion recovery) images were obtained. The Mini-Mental State Exam, and clinical outcome scores were assessed. Correlation coefficients were calculated, between MRI and clinical markers. Patients were further classified into poor-outcome and good-outcome groups based on clinical performance, and imaging parameters were compared. T2-SI ratio of centrum semiovale was compared, with that of 18 sex-matched and age-matched controls.

Results

T2-SI ratio of centrum semiovale was significantly higher in the poor-outcome group, than that in the good-outcome group and was strongly inversely correlated, with results from the Mini-Mental State Exam. ADC ratios of centrum semiovale were significantly lower in the poor outcome group than in the good outcome group, and were moderately correlated with the Mini-Mental State Exam score.

Conclusion

A higher T2-SI and a lower ratio of ADC values in the centrum semiovale, may indicate presence of more severe white matter injury and clinical impairment. T2-SI ratio and ADC values in the centrum semiovale, are useful quantitative imaging biomarkers for correlation with clinical performance in individuals with carbon monoxide intoxication.

References

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Fig. 1.
Forty-eight-year-old male with CO intoxication. (a, b) Measurement of T2 signal intensity in CS (a) and normal appearing ventral pons (b). SI ratios between affected CS and normal pons on T2-FLAIR images are calculated.
imri-23-241f1.tif
Fig. 2.
Forty-one-year-old female with CO intoxication. (a-f) ADC map (a), DWI (b), T2-FLAIR image (c) at the level of temporal lobe and ADC map (d), DWI (e), T2-FLAIR image (f) at the level of CS. T2-FLAIR image (c) shows normal-looking peripheral WM. T2-FLAIR image (f) shows bilateral symmetric confluent areas of high SI, in the CS. ROIs are placed on the involved CS (d) and normal-looking peripheral WM (a) on ADC maps. Bilateral involvement of basal ganglia, is also noted. There is no discernable SI change, in the corpus callosum.
imri-23-241f2.tif
Fig. 3.
Thirty-six-year-old male with CO intoxication, in poor-outcome group (28 days after CO exposure). (a-c) T2-FLAIR image (c) show high SI in genu of corpus callosum. ADC map (a) and DWI (b) show restricted diffusion in genu. To obtain mean ADC values, ROIs are placed on the genu and normal-looking area of splenium on ADC map, using T2-FLAIR image as reference.
imri-23-241f3.tif
Fig. 4.
Thirty-four-year-old male with CO intoxication in good-outcome group (52 days after CO exposure). ADC map (a) shows iso to slight hyperintensity, and T2-FLAIR image (c) and DWI (b) show hyperintensity in the bilateral CS.
imri-23-241f4.tif
Fig. 5.
Differences of mean T2-SI ratios in CS between good-outcome and the poor-outcome groups based on clinical outcome scoring and Mini-Mental State Examination.
imri-23-241f5.tif
Table 1.
Demographic and Clinical Characteristic of All Subjects
Variable   Total
By patient
 Age (year)   56.4 ± 15.7*
 Sex, n (%) Male 9 (50)
  Female 9 (50)
 Status, n (%) Chronic 17 (94.4)
  Subacute 1 (5.6)
 Days to evaluation (day) 46 ± 48*
By lesion
 CS T2 ratio, median (IQR) 1.241 (1.092–1.323)
 CS ADC ratio, median (IQR) 0.836 (0.740–1.091)
 CC ADC ratio, median (IQR) 1.000 (0.859–1.000)
By clinical result
 MMSE score, median (IQR) 14 (8–19)
 Clinical outcome score, median (IQR) 3 (1.25–3)

* Data are expressed as mean ± standard deviation.

ADC = apparent diffusion coefficient; CC = corpus callosum; CS = centrum semiovale; IQR = interquartile range; MMSE = Mini-Mental State Examination

Table 2.
Comparison of Characteristics Between Good and Poor Outcome Groups
Variable Good (n = 10) Poor (n = 7) Comparison (P-value)
MRI measurements
A. MMSE scores
 WM T2 ratio, median (IQR) 1.105* (1.069–1.177) 1.323* (1.317–1.398) 0.003
 WM ADC ratio, median (IQR) 0.957* (0.836–1.126) 0.713* (0.692–0.778) 0.036
 CC ADC ratio, median (IQR) 1.000 (0.822–1.000) 0.961 (0.902–1.000) 0.855
B. Clinical outcome scores
 WM T2 ratio, median (IQR) 1.131* (1.037–1.165) 1.312* (1.241–1.359) 0.044
 WM ADC ratio, median (IQR) 1.007 (0.900–1.108) 0.795 (0.715–0.836) 0.224
 CC ADC ratio, median (IQR) 1.000 (1.000–1.000) 0.922 (0.822–1.000) 0.361

Patients were classified into two groups on the basis of MMSE scores (A) and clinical outcome scores (B).

* P < 0.05

ADC = apparent diffusion coefficient; CC = corpus callosum; CS = centrum semiovale; IQR = interquartile range; MMSE = Mini-Mental State Examination; WM = white matter

Table 3.
Correlation Between MRI Measurements and Clinical Performances
MRI measurement Clinical performance
MMSE score Clinical outcome
CS T2 ratio –0.739* (P = 0.004) 0.538 (P = 0.085)
CS ADC ratio 0.669* (P = 0.032) –0.456 (P = 0.264)
CC ADC ratio 0.266 (P = 0.338) –0.419 (P = 0.264)

* P < 0.05

ADC = apparent diffusion coefficient; CC = corpus callosum; CS = centrum semiovale; IQR = interquartile range; MMSE = Mini-Mental State Examination

Table 4.
Comparison of Characteristics Between Patient and Control Groups
Variable   Patient Control Comparison (P-value)
By patient        
 Age, median (IQR)   54.5 (42.25–69.75) 54.5 (42.25–69.75) 0.281
 Sex, n (%) Male 9 (50) 11 (61.11) 0.737
  Female 9 (50) 7 (38.89)  
By lesion        
 CS T2 ratio, media an (IQR) 1.241 (1.092–1.323) 1.006 (0.947–1.046) < 0.001

CS = centrum semiovale; IQR = interquartile range

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