title: Delayed parkinsonism after CO intoxication: evaluation of the substantia nigra with inversion-recovery MR imaging.
abstract: OBJECTIVE
  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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors: Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Institute of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan.
authors: Hung-Wen
authors: HW
authors: Kao
authors: Nai-Yu
authors: NY
authors: Cho
authors: Chun-Jen
authors: CJ
authors: Hsueh
authors: Ming-Chung
authors: MC
authors: Chou
authors: Hsiao-Wen
authors: HW
authors: Chung
authors: Michelle
authors: M
authors: Liou
authors: Shih-Wei
authors: SW
authors: Chiang
authors: Shao-Yuan
authors: SY
authors: Chen
authors: Chun-Jung
authors: CJ
authors: Juan
authors: Guo-Shu
authors: GS
authors: Huang
authors: Cheng-Yu
authors: CY
authors: Chen
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D002249:Carbon Monoxide Poisoning / Q000150:complications*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D020734:Parkinsonian Disorders / Q000209:etiology* / Q000473:pathology*; D011446:Prospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013378:Substantia Nigra / Q000473:pathology*