A Preliminary Study On Quantitative Evaluation Of Brain Damage In Acute Phase After CO Intoxication With Diffusion Kurtosis Imaging

Objective: To explore the evaluation value of diffusion kurtosis imaging(DKI)for injurious degree and micro-changes of brain tissue in acute phase of CO intoxication bying measuring and analysing DKI parameters in various regions of brain.Methods: Routine MRI and DKI was performed in 26 cases with CO poisoning of acute stage(case group)and 18 healthy volunteers(control group).MK values,MD values and FA values of 15 ROI belonged to 6 groups of all subjects were measured respectively.The same voxel of ROI was drawn manually three times in the same position and palne,and the mean value as the value of parameter was got finally.Using SPSS 17.0 statistic software for data statistics.Analysis the relationships between DWI imaging findings and clinical factors.The study group was divided into two groups baesd on whether there had been lesions detected in DWI images: positive and negative group.The DKI parameters of same brain area were compared separately between two case groups and control group.Analysis the correlation respectively between two kinds of DKI parameters of MD and MK and ADC in some brain regions where there are more differences.And drawing the ROC curve of MD values and MK values in these regions and comparing areas under the curve.Calculate the best diagnostic cut-off values of quantitative evaluation of MD and MK,and their corresponding sensitivity and specificity.Analysis the diagnostic efficiency of both for brain damage in acute phase after CO intoxication.All statistic values were shown as mean value and standard deviation,and P value of <0.05 was considered statistically significant.Results:1.The positive DWI scan results were affected by a long duration of disturbance of consciousness and a early diminution of GCS score.2.Compared with the controls,,in case groups there was a significantly diminution of MD values of bilateral globus pallidus,centrum semiovale,periventricular white matter and corpus callosum genu,and MK values were increased in bilateral globus pallidus,thalamus,centrumsemiovale and periventricular white matter,and FA values of globus pallidus were reduced.Besides,in positive and negative group,MD values of globus pallidus were significantly reduced while MK values were increased,and the changes of values in others regions all belonged positive case group.3.The results indicate that there is a strong correlation respectively between the two values of MD and MK and ADC values in case groups.4.The MK values of globus pallidus had a maximum AUC(0.900),and other AUCs were,in descending order,the MD values of globus pallidus?the MK values of centrum semiovale,the MD values of centrum semiovale,the M-Kvalues of periventricular white matter,the MD values of periventricular white matter(0.867,0.856,0.844,0.822,0.789).The best diagnostic cut-off values,sensitivity and specificity of MK values and MD values in centrum semiovale,periventricular white matter and globus pallidus followed by(MKCS=1.2304;87%,83%),(MKPW=1.2516;83%,77%),(MKGP=1.0633;91%,84%),(MDCS=0.8736;93%,70%),(MDPW=0.8522;90%,73%),(MDGP=0.9445;86%,81%).The above differences were statistically significant(P<0.05).Conclusion:1.DKI techniques can assess quantitatively and diagnose brain damage in acute phase of CO intoxication.2.The two DKI parameters of MK and MD can reflect micro-structural information of brain tissue in acute phase of CO intoxication,especially,MK can reflect microstructural changes of grey matter.They both can sensitively find the abnormity of grey or white matter in acute phase of CO intoxication and are conducive to assess clinical severity objectively,intervene early and treat appropriately.