Clinical significance of fractional anisotropy in cerebral white matter regional vulnerability caused by carbon monoxide poisoning: A systematic review and meta-analysis

Wen Chiu Hsiao, Rui Nouchi, Hsin I. Chang, Shih Wei Hsu, Chen Chang Lee, Shu Hua Huang, Chi Wei Huang, Chiung Chih Chang*, Chia Hsiung Cheng*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

Abstract

Carbon monoxide poisoning (COP) can lead to various cerebral white matter (WM) lesions across different disease phases and clinical manifestations, and fractional anisotropy (FA) of diffusion tensor imaging has been widely applied to investigate WM injury in these patients. Here we conducted a systematic review and meta-analysis to investigate the utility of FA in evaluating the regional vulnerability of WM injury caused by COP and explore differences between different disease phases and patient subtypes. We systematically searched PubMed, Medline, Scopus and reference lists of appropriate publications to identify relevant studies. Eight studies with 217 patients with COP and 207 healthy controls (HCs) were included. Eight regions of interest were available to investigate regional vulnerability. The results showed the most significant decrease in FA in orbitofrontal subcortical regions. Comparisons of different disease phases revealed lower FA in the centrum semiovale and corpus callosum in the acute phase, while in the chronic phase, only FA in the centrum semiovale remained significantly decreased. Analysis of different patient subtypes showed that the FA values in the splenium of the corpus callosum were significantly decreased in the patients with delayed neurologic sequelae (DNS) but not in the mixed population (with and without DNS). In conclusion, this meta-analysis highlights the frontal-subcortical regional vulnerability in COP. FA changes in the corpus callosum across different disease phases reflect alterations in underlying microstructures. Extended corpus callosum injury involving the splenium could be an imaging biomarker of the occurrence of DNS.

Original languageEnglish
Pages (from-to)92-100
Number of pages9
JournalNeuroToxicology
Volume96
DOIs
StatePublished - 05 2023

Bibliographical note

Copyright © 2023 Elsevier B.V. All rights reserved.

Keywords

  • Carbon monoxide poisoning
  • Corpus callosum injury
  • Delayed neurologic sequelae
  • Fractional anisotropy
  • Frontal-regional vulnerability
  • Anisotropy
  • Clinical Relevance
  • Humans
  • Carbon Monoxide Poisoning/complications
  • White Matter/diagnostic imaging
  • Diffusion Tensor Imaging/methods

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