一氧化碳中毒与中毒后迟发性脑病的大脑磁共振成像比较

MRI-based comparison of brain damage between acute carbon monoxide poisoning and delayed encephalopathy after acute carbon monoxide poisoning

目的 探讨单纯一氧化碳（CO）中毒和CO中毒后迟发性脑病磁共振（MRI）特点,以及二者脑损伤程度的差异.方法 回顾性分析经临床确诊的27例单纯急性CO中毒的患者和35例CO中毒后迟发性脑病的患者的临床和MRI资料,选取10例健康志愿者作为对照组.所有受试者均行常规MRI及DWI扫描,采用圆形感兴趣区（ROI）分别对称性测量苍白球、侧脑室周围白质、半卵圆中心平均表观弥散系数（ADC）值,并对ADC值进行比较.结果 27例CO中毒患者中,13例CO中毒患者的MRI表现为双侧苍白球对称性异常信号,其中8例为单纯苍白球区受累,5例并发有其他部位受累.8例CO中毒患者的皮质及皮质下白质区受累,4例表现为双侧脑室周围及双侧半卵圆中心弥漫性异常信号.2例CO中毒患者表现为多部位同时受累.35例CO中毒后迟发性脑病患者的MRI表现为脑实质内多个部位对称性脱髓鞘改变,脑组织弥漫性肿胀,33例累及到脑室周围白质及半卵圆中心,23例累及到脑深部的神经核团,3例可见脑皮层受累.CO中毒组和CO中毒后迟发性脑病组脑室周围白质及双侧半卵圆中心的ADC值明显低于正常对照组,且CO中毒后迟发性脑病患者的ADC值明显低于CO中毒患者,差异有统计学意义（P＜0.05）.CO中毒组苍白球区ADC值明显低于正常对照组,差异有统计学意义（P＜0.05）;CO中毒后迟发性脑病患者苍白球区ADC值明显高于和CO中毒组和正常对照组,差异有统计学意义（P＜0.05）.结论 常规MRI和ADC值能够从病变累及的范围和从更微观的角度评价CO中毒和CO中毒后迟发性脑病患者的脑组织损伤程度,对治疗方案的选择和预后的评估提供有价值的信息.

Objective To study the MRI-based characteristics of acute carbon monoxide poisoning （ACOP） and delayed encephalopathy after acute carbon monoxide poisoning （DECAMP）,and to compare the degree of brain damage.Methods A retrospective analysis was performed on the clinical and MRI data of 27 patients diagnosed with ACOP and 35 patients diagnosed with DECAMP.Ten healthy volunteers were recruited in the normal control group.All subjects received both routine MRI and diffusion-weighted MRI.Apparent diffusion coefficient （ADC） was determined with symmetric measurement of region of interest in the bilateral globus pallidus,white matter around lateral ventricle,and centrum semiovale.ADC values were compared afterwards.Results Thirteen of the 27 ACOP cases were found of symmetrical abnormal signal in the bilateral globus pallidus,among whom 8 patients only showed pallidum region involvement,while the other 5 patients showed involvement of other regions.Eight ACOP patients showed cortical and subcortical white matter involvement,and 4 cases showed diffused abnormal signal around the bilateral ventricles and in the bilateral centrum semiovale.Two cases of ACOP presented with multiple region involvement.Thirty-five DECAMP patients showed diffused swelling and symmetric demyelination in multiple regions of the brain parenchyma.The periventricular white matter and centrum semiovale were involved in 33 cases,the deep brain nuclei were involved in 23 cases,and the cerebral cortex was involved in 3 cases.The ACOP and DECAMP groups had significantly lower ADC values in the periventricular white matter and bilateral centrum semiovale than the normal control group （P〈0.05）,and the ADC values were significantly lower in the DECAMP group than in the ACOP group （P〈0.05）.The ACOP group had a significantly lower ADC value in the globus pallidus than the DECAMP group and normal control group （P〈 0.05）; the DECAMP group had a significantly higher ADC value in the globus pallidus than the ACOP group and normal control group （P〈0.05）.Conclusion Routine MRI and ADC value can evaluate the degree of brain damage in ACOP and DECAMP patients based on lesion involvement on a more microscopic scale.It can provide valuable information for therapy selection and prognostic evaluation.