Initial diffusion-weighted MRI and long-term neurologic outcomes in charcoal-burning carbon monoxide poisoning

• Published in: Clinical toxicology (Philadelphia, Pa.) Vol. 56; no. 3; pp. 161 - 169
• Main Authors: Moon, J. M., Chun, B. J., Baek, B. H., Hong, Y. J.
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 04-03-2018
• Subjects: Adult; Aged; carbon monoxide; Carbon Monoxide Poisoning - diagnosis; Carbon Monoxide Poisoning - therapy; Charcoal; Charcoal - poisoning; diffusion magnetic resonance imaging; Diffusion Magnetic Resonance Imaging - methods; Female; Humans; Male; Middle Aged; Nervous System Diseases - diagnosis; Nervous System Diseases - etiology; Nervous System Diseases - therapy; outcome; poisoning; Treatment Outcome; carbon monoxide; diffusion magnetic resonance imaging; poisoning; outcome; Charcoal
• ISSN: 1556-3650; 1556-9519
• DOI: 10.1080/15563650.2017.1352098

Context: This study assessed the results of diffusion-weighted imaging (DWI) at presentation for acute charcoal-burning carbon monoxide (CO) poisoning and investigated whether the initial DWI results can predict long-term neurologic outcomes.
Methods: The study included 128 patients who suffered from CO poisoning after burning charcoal and underwent DWI. These patients were divided into two groups based on imaging results: a normal DWI group and an abnormal DWI group. Data regarding clinical courses and long-term neurologic outcomes (persistent severe neurologic sequelae) were collected and compared.
Results: The rate of abnormal DWI findings at presentation was 23.4%, and the most common site of abnormalities was the globus pallidus. All lesions in abnormal DWI had decreased apparent diffusion coefficient (ADC) values. The long-term neurologic state was assessed at a median follow-up of 19.5 months, and the frequency of poor long-term neurologic outcome was significantly higher in the abnormal DWI group (40.0% in the abnormal DWI group vs. 1.0% in the normal DWI group; p < .001). Abnormal DWI (odds ratio [OR]): 31.3, 95% confidence interval [CI]: 2.5-397) and old age (OR 1.1, 95% CI: 1.001-1.13) were independent factors for poor long-term neurologic outcomes, whereas the Glasgow Coma Scale score at presentation (OR: 0.7, 95% CI: 0.6-0.9) was negatively associated with the risk of poor long-term neurologic outcome.
Conclusions: In cases involving CO poisoning due to charcoal burning, DWI at presentation may help predict the long-term neurological outcome after discharge.