title: Diffusion-weighted imaging improves prediction in cognitive outcome and clinical phases in patients with carbon monoxide intoxication.
abstract: BACKGROUND
  Changes in apparent diffusion coefficient (ADC) values often reflect tissue injury. Use of ADC as a surrogate marker to assess clinical phases has not been systemically applied in patients with carbon monoxide (CO) intoxication.
  
  
  METHODS
  Fifty-nine magnetic resonance imaging scans and cognitive evaluations were performed in 47 patients with CO intoxication and compared with 22 sex- and age-matched controls. The patients were further classified into three groups based on the clinical phases, namely, acute (within 2 weeks), delayed neuropsychiatric (2 weeks to 6 months), and chronic (>1 year) groups. The ADC values were measured in 16 regions of interests (ROIs) and correlated with cognitive test scores.
  
  
  RESULTS
  Among the 59 evaluations, 15 were in the acute, 26 in the delayed neuropsychiatric, and 18 in the chronic groups. Among the ROIs, significant elevations of ADC values were found in the corpus callosum and globus pallidus in all three CO phases compared with the controls, and the ADC values were highest in the chronic phases. In contrast, the ADC values in peripheral gray matter and white matter were highest in the delayed neuropsychiatric group. Both globus pallidus and corpus callosum ADC values correlated with multiple cognitive test scores.
  
  
  CONCLUSIONS
  Using ADC as a surrogate marker, the globus pallidus and corpus callosum can be considered to be two vulnerable structures in the gray and white matter. Significant differences between ADC values correlated well with clinical phase and cognitive performance.
authors.affiliation: Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, #123, Ta-Pei Road, Niaosung, Kaohsiung County 833, Taiwan.
authors.forename: Nai-Ching
authors.initials: NC
authors.lastname: Chen
authors.forename: Chi-Wei
authors.initials: CW
authors.lastname: Huang
authors.forename: Chun-Chung
authors.initials: CC
authors.lastname: Lui
authors.forename: Chen-Chang
authors.initials: CC
authors.lastname: Lee
authors.forename: Wen-Neng
authors.initials: WN
authors.lastname: Chang
authors.forename: Shu-Hua
authors.initials: SH
authors.lastname: Huang
authors.forename: Ching
authors.initials: C
authors.lastname: Chen
authors.forename: Chiung-Chih
authors.initials: CC
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D002249:Carbon Monoxide Poisoning / Q000150:complications* / Q000175:diagnosis*; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology*; D003337:Corpus Callosum / Q000187:drug effects / Q000473:pathology*; D005260:Female; D005917:Globus Pallidus / Q000187:drug effects / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity