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Original Research

Open Access

Predictors exploration of abnormal brain magnetic resonance versus normal brain computed tomography imaging in acute carbon monoxide poisoning

  • Sangun Nah1
  • Sungwoo Choi1
  • Jungbin Lee2
  • Ji Eun Moon3
  • Young Hwan Lee1
  • Sangsoo Han1

1Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, 14584 Bucheon, Republic of Korea

2Department of Radiology, Soonchunhyang University Bucheon Hospital, 14584 Bucheon, Republic of Korea

3Department of Biostatistics, Clinical Trial Center, Soonchunhyang University Bucheon Hospital, 14584 Bucheon, Republic of Korea

DOI: 10.22514/sv.2021.248

Submitted: 22 August 2021 Accepted: 23 November 2021

Online publish date: 29 December 2021

*Corresponding Author(s): Young Hwan Lee E-mail:
*Corresponding Author(s): Sangsoo Han E-mail:


Acute brain lesions observed on magnetic resonance imaging (MRI) performed during acute-phase carbon monoxide (CO) poisoning were associated with patient prognosis. However, it may be difficult in critically ill patients because of the long examination time and for patients who have economical limitations due to the high price. The purpose of this study was to identify predictive factors for abnormal brain lesions on MRI in cases of normal brain findings on brain computed tomography (CT) in acute CO poisoning patients. This study was retrospectively analyzed at the tertiary emergency medical center located in Gyeonggi-do, Korea by prospectively collecting CO poisoning registry. From August 2016 to August 2019, 287 patients visited the hospital due to CO poisoning. Exclusion criteria included age under 18 years, being discharged against medical advice, no initial MRI data, no initial CT data, and having abnormal lesions on brain CT. Of the 103 patients included in the final study, the median age was 39 years old; 35 (34.0%) were male and 74 (71.8%) were intentionally exposed to CO. 27 (26.2%) patients had abnormal MRI findings. Based on multivariable analysis, elevated blood urea nitrogen (BUN) concentration (odds ratio, 1.165; 95% confidence interval, 1.037–1.308; p = 0.01) showed a significant association with abnormal MRI findings. The area under the curve was 0.753 (95% confidence interval, 0.636–0.869) in the receiver operating characteristic curve of BUN concentration for abnormal brain MRI presentations. Brain injury may be detected on brain MRI in acute CO poisoning patients even there was a normal brain CT scan. Our study revealed that elevated BUN concentration may be significantly correlated with abnormal MRI findings.


Blood urea nitrogen; Carbon monoxide poisoning; Computed tomography; Hypoxic ischemic encephalopathy; Magnetic resonance imaging

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Sangun Nah,Sungwoo Choi,Jungbin Lee,Ji Eun Moon,Young Hwan Lee,Sangsoo Han. Predictors exploration of abnormal brain magnetic resonance versus normal brain computed tomography imaging in acute carbon monoxide poisoning. Signa Vitae. 2022.doi:10.22514/sv.2021.248.


[1] Hampson NB. Cost of accidental carbon monoxide poisoning: a preventable expense. Preventive Medicine Reports. 2016; 3: 21–24.

[2] Ernst A, Zibrak JD. Carbon monoxide poisoning. The New England Journal of Medicine. 1998; 339: 1603–1608.

[3] Rodkey FL, O’Neal JD, Collison HA, Uddin DE. Relative Affinity of Hemoglobin S and Hemoglobin a for Carbon Monoxide and Oxygen. Clinical Chemistry. 1974; 20: 83–84.

[4] Guzman JA. Carbon monoxide poisoning. Critical Care Clinics. 2012; 28: 537–548.

[5] Jeon SB, Sohn CH, Seo DW, Oh BJ, Lim KS, Kang DW, et al. Acute Brain Lesions on Magnetic Resonance Imaging and Delayed Neurolog-ical Sequelae in Carbon Monoxide Poisoning. JAMA Neurology. 2018; 75: 436–443.

[6] Moon JM, Chun BJ, Baek BH, Hong YJ. Initial diffusion-weighted MRI and long-term neurologic outcomes in charcoal-burning carbon monoxide poisoning. Clinical Toxicology. 2018; 56: 161–169.

[7] Kim JG, Lee HB, Jeon SB. Combination of Dexmedetomidine and Ketamine for Magnetic Resonance Imaging Sedation. Frontiers in Neurology. 2019; 10: 416.

[8] Kanaya N, Imaizumi H, Nakayama M, Nagai H, Yamaya K, Namiki A. The utility of MRI in acute stage of carbon monoxide poisoning. Intensive Care Medicine. 1992; 18: 371–372.

[9] Weaver LK, Hopkins RO, Chan KJ, Churchill S, Elliott CG, Clemmer TP, et al. Hyperbaric oxygen for acute carbon monoxide poisoning. The New England Journal of Medicine. 2002; 347: 1057–1067.

[10] Oh S, Choi SC. Acute carbon monoxide poisoning and delayed neurological sequelae: a potential neuroprotection bundle therapy. Neural Regeneration Research. 2015; 10: 36–38.

[11] Moriwaka F, Tashiro K, Matsuura T, Akino M, Saito H, Tajima S. Carbon monoxide (CO) poisoning. CT Kenkyu. 1986; 8: 322–325.

[12] Horowitz AL, Kaplan R, Sarpel G. Carbon monoxide toxicity: MR imaging in the brain. Radiology. 1987; 162: 787–788.

[13] Jalukar V, Penney DG, Crowley M, Simpson N. Magnetic resonance imaging of the rat brain following acute carbon monoxide poisoning. Journal of Applied Toxicology. 1993; 12: 407–414.

[14] Kim JH, Durey A, Han SB, Kim JH. Predictive factors for acute brain lesions on magnetic resonance imaging in acute carbon monoxide poisoning. The American Journal of Emergency Medicine. 2020; 38: 1825–1830.

[15] Hampson NB, Bodwin D. Toxic CO-ingestions in intentional carbon monoxide poisoning. The Journal of Emergency Medicine. 2013; 44: 625–630.

[16] Lee HL, Lin HJ, Yeh SY, Chi CH, Guo HR. Etiology and outcome of patients presenting for poisoning to the emergency department in Taiwan: a prospective study. Human and Experimental Toxicology. 2008; 27: 373–379.

[17] Kao HK, Lien TC, Kou YR, Wang J. Assessment of myocardial injury in the emergency department independently predicts the short-term poor outcome in patients with severe carbon monoxide poisoning receiving mechanical ventilation and hyperbaric oxygen therapy. Pulmonary Pharmacology and Therapeutics. 2009; 22: 473–477.

[18] Moon JM, Chun BJ, Lee SD, Jung EJ. Serum neuron-specific enolase levels at presentation and long-term neurological sequelae after acute charcoal burning-induced carbon monoxide poisoning. Clinical Toxicol-ogy. 2018; 56: 751–758.

[19] Baek SO, Hwang SM, Moon YH. Carbon Monoxide Pollution in Korea: Public Health Implications. Indoor and Built Environment. 1999; 8: 156–167.

[20] Chang SS, Chen YY, Yip PS, Lee WJ, Hagihara A, Gunnell D. Regional changes in charcoal-burning suicide rates in East/Southeast Asia from 1995 to 2011: a time trend analysis. PLoS Medicine. 2014; 11: e1001622.

[21] Sircar K, Clower J, Shin MK, Bailey C, King M, Yip F. Carbon monoxide poisoning deaths in the United States, 1999 to 2012. The American Journal of Emergency Medicine. 2015; 33: 1140–1145.

[22] Sefer S, Degoricija V, Degoricia V, Bilić B, Trotić R, Milanović-Stipković B, et al. Acute carbon monoxide poisoning as the cause of rhabdomyolysis and acute renal failure. Acta Clinica Croatica. 1999; 53: 199–202.

[23] Bosch X, Poch E, Grau JM. Rhabdomyolysis and Acute Kidney Injury. New England Journal of Medicine. 2009; 361: 62–72.

[24] Kim SG, Woo J, Kang GW. A case report on the acute and late complications associated with carbon monoxide poisoning: Acute kidney injury, rhabdomyolysis, and delayed leukoencephalopathy. Medicine. 2019; 98: e15551.

[25] Aronson D, Hammerman H, Beyar R, Yalonetsky S, Kapeliovich M, Markiewicz W, et al. Serum blood urea nitrogen and long-term mortality in acute ST-elevation myocardial infarction. International Journal of Cardiology. 2008; 127: 380–385.

[26] Sugimoto T, Kashiwagi A. No elevation of blood urea level in a dehydrated patient with central diabetes insipidus. QJM: Monthly Journal of the Association of Physicians. 2007; 100: 800.

[27] Pan KT, Shen CH, Lin FG, Chou Y, Croxford B, Leonardi G, et al. Prognostic factors of carbon monoxide poisoning in Taiwan: a retrospective observational study. BMJ Open. 2019; 9: e031135.

[28] Gedela M, Weltman NY, Chavvakula NS, Carpenter PL, Sturm T. Atrial fibrillation induced by carbon monoxide poisoning and successful treatment with hyperbaric oxygen. South Dakota medicine: the journal of the South Dakota State Medical Association. 2017; 70: 319–321.

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