Delayed parkinsonism after CO intoxication: Evaluation of the substantia nigra with inversion-recovery MR imaging

Hung Wen Kao, Nai Yu Cho, Chun Jen Hsueh, Ming Chung Chou, Hsiao Wen Chung, Michelle Liou, Shih Wei Chiang, Shao Yuan Chen, Chun Jung Juan, Guo Shu Huang, Chen Yu Chen

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)


Purpose: 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. Materials and 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 normalappearing 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). Conclusion: 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.

Original languageEnglish
Pages (from-to)215-221
Number of pages7
Issue number1
Publication statusPublished - Oct 2012
Externally publishedYes

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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