Associations of MRI indirect derived glymphatic system impairment with acute carbon monoxide poisoning and delayed...

To assess the glymphatic function utilizing diffusion tensor imaging along the perivascular space (DTI-ALPS) indices in acute carbon monoxide poisoning (ACOP) and subsequent delayed neurological sequelae (DNS).

A total of 76 participants were included and categorized into ACOP (n = 51) and healthy controls (HCs, n = 25), and the ACOP groups were further divided into DNS (n = 26) and non-DNS (n = 25) subgroups. Demographic and clinical variables were included. Group differences were analyzed, and correlations between the DTI-ALPS index and clinical parameters were assessed. Multivariate logistic regression was performed to evaluate the predictive value of sex, age, blood lactate, CO exposure time, COHb, and DTI-ALPS index in classifying DNS patients.

Significant differences in left DTI-ALPS, right DTI-ALPS and mean DTI-ALPS index were observed between the ACOP and HC groups (d = -0.18 [-0.32, -0.10], FWE-corrected p < 0.001), and between the non-DNS and DNS groups (d = -0.17 [-0.21, -0.05], FWE-corrected p < 0.01). The logistic regression model showed that CO exposure time, lactic acid, left DTI-ALPS, right DTI-ALPS, and mean DTI-ALPS were associated with a higher occurrence of DNS (p = 0.018, p = 0.019, p = 0.032, p = 0.038, p = 0.026, respectively), with an area under the curve of 0.98, sensitivity of 0.96, specificity of 0.92, positive predictive value of 0.92, and negative predictive value of 0.92. Additionally, CO exposure time, COHb levels, and blood lactate levels were significantly negatively correlated with DTI-ALPS indices CONCLUSIONS: The DTI-ALPS index serves as a potential imaging biomarker for brain damage associated with ACOP and DNS, indicating the involvement of glymphatic dysfunction in the pathophysiology of these conditions.