Predictive factors for acute brain lesions on magnetic resonance imaging in acute carbon monoxide poisoning



      Acute brain lesions on diffusion-weighted-magnetic resonance imaging (MRI) after acute carbon monoxide (CO) poisoning were associated with delayed neurological sequelae. This study was conducted to identify the risk factors associated with acute brain lesions on MRI after acute CO poisoning and to help select patients who need acute-phase brain MRI after acute CO poisoning in the emergency department (ED).


      This retrospective observational study included 103 adult patients who were hospitalized at a tertiary-care hospital between November 2016 and September 2019 and underwent brain MRI because of acute CO poisoning. Multivariable logistic regression analysis was applied to identify predictive factors for acute brain lesions on MRI after acute CO poisoning.


      Multivariable logistic regression analysis showed that Glasgow Coma Scale (GCS) score of <9 at ED presentation (odds ratio [OR] 17.749, 95% confidence interval [CI] 3.098–101.690, P = 0.001) and the initial troponin-I level at presentation in the ED (OR 13.657, 95% CI 1.415–131.834, P = 0.024) were predictive factors for acute brain lesions on MRI in acute CO poisoning. The receiver operating characteristics curve for initial troponin-I showed an area under the curve of 0.761 (95% CI 0.638–0.883, P < 0.001) and the optimal cutoff value was 0.105 ng/mL.


      Acute-phase brain MRI in acute CO poisoning can be considered for patients who present at the ED with a GCS score <9 or troponin-I level >0.105 ng/mL.


      DW-MRI (diffusion-weighted-magnetic resonance imaging), ED (emergency department), CO (carbon monoxide), GCS (Glasgow Coma Scale), OR (odds ratio), CI (confidence interval), ROC (receiver operating characteristics), AUC (area under the curve), HBOT (hyperbaric oxygen therapy)


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