Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 7278  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Resource Links
  »  Similar in PUBMED
 »  Search Pubmed for
 »  Search in Google Scholar for
 »Related articles
  »  Article in PDF (1,021 KB)
  »  Citation Manager
  »  Access Statistics
  »  Reader Comments
  »  Email Alert *
  »  Add to My List *
* Registration required (free)  

  In this Article
 »  Abstract
 »  Introduction
 »  Case Report
 »  Discussion
 »  References
 »  Article Figures
 »  Article Tables

 Article Access Statistics
    PDF Downloaded38    
    Comments [Add]    
    Cited by others 8    

Recommend this journal


Table of Contents    
Year : 2011  |  Volume : 59  |  Issue : 1  |  Page : 108-110

Diagnosis and prognosis evaluation of 1,2-dichloroethane encephalopathy - Magnetic resonance imaging combined with diffusion tensor imaging and magnetic resonance spectroscopy study

1 Department of Radiology, The Second Affiliated Hospital, Medical College of Shantou University, Shantou, China
2 Department of Neurology, The Second Affiliated Hospital, Medical College of Shantou University, Shantou, China

Date of Submission26-Aug-2010
Date of Decision15-Sep-2010
Date of Acceptance18-Nov-2010
Date of Web Publication18-Feb-2011

Correspondence Address:
Wenbin Zheng
Department of Radiology, The Second Affiliated Hospital, Medical College of Shantou University, Shantou 515 041
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0028-3886.76884

Rights and Permissions

 » Abstract 

Neuroimaging findings in 1,2-dichloroethane (1,2-DCE) encephalopathy have seldom been reported. We present the comprehensive neuroimaging findings, conventional magnetic resonance imaging (MRI) combined with diffusion tensor imaging (DTI) and 1 H-magnetic resonance spectroscopy ( 1 H-MRS), in a case of 1,2-DCE encephalopathy. On day-4 the signal intensity of the lesions on diffusion-weighted imaging (DWI) was higher than that with T2-weighted imaging (T2WI); mean apparent diffusion coefficient (ADC) values for lesions were lower than control values. On day-20, the mean ADC value was increased gradually, whereas the mean fractional anisotropy (FA) of the lesions was significantly reduced. 1 H-MRS showed reduced ratios of N-acetyl aspartate to creatinine (NAA/Cr) and NAA to choline (NAA/Cho) on day-20 as compared with the control values. Combining conventional MRI with DTI and MRS is valuable in the early diagnosis and prognosis of 1,2-DCE-induced encephalopathy.

Keywords: 1, 2-Dichloroethane poisoning, DTI, encephalopathy, MR spectroscopy

How to cite this article:
Zhan F, Zheng W, Liu L, Kong L. Diagnosis and prognosis evaluation of 1,2-dichloroethane encephalopathy - Magnetic resonance imaging combined with diffusion tensor imaging and magnetic resonance spectroscopy study. Neurol India 2011;59:108-10

How to cite this URL:
Zhan F, Zheng W, Liu L, Kong L. Diagnosis and prognosis evaluation of 1,2-dichloroethane encephalopathy - Magnetic resonance imaging combined with diffusion tensor imaging and magnetic resonance spectroscopy study. Neurol India [serial online] 2011 [cited 2023 Dec 1];59:108-10. Available from:

 » Introduction Top

1,2-dichloroethane (1,2-DCE) is a commonly used industrial solvent. [1] People working as spray painters and printers are occupationally exposed to DCE, which can be inhaled or taken up through the skin and may cause 1,2-DCE encephalopathy. [2],[3] We aim to investigate the value of conventional magnetic resonance imaging (MRI) combined with functional MRI in the early diagnosis and prognostic evaluation of 1,2-DCE-encephalopathy, and ultimately, to provide a more reliable basis for clinical diagnosis and treatment.

 » Case Report Top

A 20-year-old man, who was occupationally exposed to 1,2-DCE for six months, presented with headache, dizziness, nausea, vomiting, and a slow response to verbal commands. Laboratory test results were normal. Computed tomography (CT) of the brain showed shallow sulci, widened gyri, and symmetrical hopodensities in both the white matter and the external capsule. He was treated with tranquilizers, mannitol and dexamethasone.

He underwent magnetic resonance imaging (MRI) using a GE 1.5-T MR scanner equipped with high-performance gradients. Diffusion tensor imaging (DTI) and 1 H-magnetic resonance spectroscopic imaging ( 1 H-MRS) were also done. Regions of interest of 31.6 mm 2 were located inside the abnormal signal region for apparent diffusion coefficient (ADC), fractional anisotropy (FA), and metabolic changes measurements. Imaging data for the lesions were measured automatically with the scanner's software (GE Medical System). Correlations between time of MRI and mean ADC and FA values, including those for normal controls, were analyzed by ANOVA. Statistical analysis was performed using SPSS v15.0 software (SPSS Inc., Chicago, IL).

T2-weighted imaging (T2WI) on day-4 of hospitalization showed bilateral, moderate, and diffuse high-signal intensity in the subcortical white matter. DWI revealed hemispheric lesions with high-signal intensity and low-mean ADC (5.066 ± 0.736 × 10-4 mm 2 /s) in the corresponding areas [Figure 1]a. On 1 H-MRS, the ratios of N-acetyl aspartate to creatinine (NAA/Cr), choline to creatinine (Cho/Cr), and NAA to Cho (NAA/Cho) for the lesions were 1.632 ± 0.138, 0.971 ± 0.135, and 1.719 ± 0.338, respectively [Table 1]. On day 20, brain MRI revealed increased signal intensity of the bilateral lesions and external capsule on T2WI and DWI with increased mean ADC (7.510 ± 0.428 × 10-4 mm 2 /s) [Figure 1]b. The NAA/Cr and NAA/Cho ratios were reduced and the Cho/Cr ratio was increased [Table 1]. At seven weeks, T2WI and DWI revealed reduced high-signal intensity in the focus [Figure 1]c and the mean ADC value was further increased (8.539 ± 0.709 × 10-4 mm 2 /s). The mean FA values for the three successive DTI were lower than the values of normal controls and with the most severely reduced FA value at day 20.
Table 1: Diffusion tensor imaging and magnetic resonance spectroscopy derived values based on the lesions of subcortical white matter of the patient and corresponding areas in healthy controls

Click here to view
Figure 1: Neuroimaging findings of the patient (a) On day 4 of hospitalization, diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) images show symmetrically restricted diffusion in bilateral subcortical white matter, whereas the T2-weighted image shows only subtle hyper intensive signals (b) On day 20, MRI shows increased restricted diffusion on DWI as well as extended focus area (c) MRI at 7 weeks shows reduced highsignal intensity in the focus and reduced focus area. The ADC map shows hyperintense signals

Click here to view

All the results of the MRI examination were compared with those of the healthy controls (n = 4, age 20−25 years old) [Table 1]. FA values for the three examinations and ADC values on day four and week seven, significantly differed from those of the normal controls and there were significant differences among the mean ADC values for the three examinations (P < 0.05). The neuronal metabolite ratios (NAA/Cho, Cho/Cr) by 1 H-MRS were correlated with FA values on day-20 (r = 0.458, P < 0.05; r = −0.497, P < 0.01).

 » Discussion Top

This patient is remarkable for its neuroimaging findings using conventional MRI combined with DTI and 1 H-MRS. [4] DTI is a technique based on measurement of the  Brownian motion More Details of water molecules. It has been used to evaluate various physiological and pathological processes. [5] The two commonly used DTI-derived measurements are FA and ADC. 1 H-MRS is a non-invasive method for detecting and quantifying biochemical cerebral disturbances in metabolic encephalopathy.

Previous studies showed that cerebral edema is a common major characteristic feature of acute and subacute DCE encephalopathy. [6],[7] A low ADC is reported to be associated with poor prognosis in experimental ischemia models, and ADC values from 4.50 to 5.50 × 10 -4 mm 2 /s were suggested as a threshold for irreversible damage. [8] There is a negative linear correlation between ADC value and the degree of cytotoxic edema. [9] In our patient, DTI examination revealed a low ADC value in the acute stage (day-4) and a higher ADC value in the subacute stage (day-20). Combined with the DWI features, we can conclude that edema was mainly cytotoxic in the acute stage, but vasogenic in the subacute stage. These observations are consistent with several other reports. [6],[10]

Although the intracellular function is not clear, NAA is found predominantly within neurons, and thought to be a neuronal axonal marker. In this patient, the NAA/Cho ratio decreased on day-20 and the mean FA levels reached the lowest at the same time, reflecting some degree of neuronal necrosis and white matter demyelination. These findings also favored the increased T2 signal hyperintensity with widened focus area on day-20 and are consistent with previous reports on organic solvent poisoning and multiple sclerosis. [11],[12] Therefore, the FA values, NAA content, and neuronal structure may be associated or independent of the pathology involved.

In the early phase, DWI can reveal extensive brain changes earlier than with conventional T2WI. Changes in ADC values could explain the formation of brain edema and corresponding brain symptoms in the patient. DTI and 1 H-MRS were more sensitive in detecting and demonstrating the extent of cerebral lesions than routine MRI. The dynamic changes in FA values and neuronal metabolite ratios derived from DTI and MRS sequences can objectively reflect the degree of nerve damage and progression of brain damage. All these further our understanding of the mechanism of 1,2-DCE encephalopathy and may provide valuable information in its diagnosis and prognosis.

 » References Top

1.Li LY, Chen BJ. Status of occupational organic solvent poisoning and countermeasures in Guangdong. Chin Occup Med 1998;25:38-40.  Back to cited text no. 1
2.Hu YH, Ma L, Wang S, Feng KY. Clinical analysis on four cases of toxic leukoencephalopathy induced by dichloroethane. Chin J Ind Med 2007;20:95-6.  Back to cited text no. 2
3.Niu Q, Yang LJ, Liang YX, Li LY. Study on morphology of brain tissue induced by inhale 1,2-dichloroethane. J Hyg Res 2002;31:340-1.  Back to cited text no. 3
4.Ridgway P, Nixon TE, Leach JP. Occupational exposure to organic solvents and long-term nervous system damage detectable by brain imaging, neurophysiology or histopathology. Food Chem Toxicol 2003;41:153-87.  Back to cited text no. 4
5.Basser PJ, Mattiello J, Le Bihan D. Estimation of the effective self-diffusion tensor from the NMR spin echo. J Magn Reson B 1994;103:247-54.   Back to cited text no. 5
6.Zhang QL, Wang LP, Guo XL. Effect of 1, 2-dichloroethane on blood brain barrier. Chin J Ind Hyg Occup Dis 2006;24:239-42.  Back to cited text no. 6
7.Sun DY, Zhang XM. Head MRI analysis on 8 cases of subacute 1,2-dichloroethane poisoning. Chin J Ind Med 2010;23:99-100.  Back to cited text no. 7
8.Dardzinski BJ, Sotak CH, Fisher M, Hasegawa Y, Li L, Minematsu K. Apparent diffusion coefficient mapping of experimental focal cerebral ischemia using diffusion-weighted echo-planar imaging. Magn Reson Med 1993;30:318-25.  Back to cited text no. 8
9.Sevick RJ, Kanda F, Mintorovitch J, Arieff AI, Kucharczyk J, Tsuruda JS. Cytotoxic brain edema: Assessment with diffusion weighted MR imaging. Radiology 1992;185:687-90.  Back to cited text no. 9
10.Liu QX, Xia S, Qi J. Imaging features of toxic encephalopathy and the values of DWI. Chin J Med Imaging Technol 2009;25:54-7.  Back to cited text no. 10
11.Sijens PE, Irwan R, Potze JH, Mostert JP, De Keyser J, Oudkerk M. Analysis of the human brain in primary progressive multiple sclerosis with mapping of the spatial distributions using 1H MR spectroscopy and diffusion tensor imaging. Eur Radiol 2005;15:1686-93.  Back to cited text no. 11
12.Rasalkar DD, Chu WC, Cheung K, Yeung DK, Shi L, Wang D, et al. Magnetic resonance changes with spectroscopy and diffusion tensor imaging after acute cyanide poisoning in a child. Eur J Radiology Extra 2010;73:e5-8.  Back to cited text no. 12


  [Figure 1]

  [Table 1]

This article has been cited by
1 CircBCL11B acts as a ceRNA to facilitate 1,2-dichloroethane-induced astrocyte swelling via miR-29b-3p/AQP4 axis in SVG p12 cells
Yizhou Zhong, Bingli Zhang, Yuji Huang, Jiaxin Du, Boxuan Liang, Zhiming Li, Rongyi Ye, Bo Wang, Hongyi Xian, Xifei Yang, Weifeng Rong, Xiang Guo, Xingfen Yang, Zhenlie Huang
Toxicology Letters. 2023;
[Pubmed] | [DOI]
2 1,2-Dichloroethane induces cerebellum granular cell apoptosis via mitochondrial pathway in vitro and in vivo
Manqi Huang, Yizhou Zhong, Li Lin, Boxuan Liang, Jun Liu, Junying Jiang, Manjiang Hu, Yuji Huang, Xi Lin, Lvliang Lu, Ziwei Bian, Wenyu Zhong, Jiejiao Wu, Jiewei Zheng, Weifeng Rong, Yating Zhang, Liang Jiang, Jieling Wu, Xin Zhang, Xingfen Yang, Qiansheng Hu, Zhenlie Huang
Toxicology Letters. 2020; 322: 87
[Pubmed] | [DOI]
3 Comparison of quantitative T 2 and ADC mapping in the assessment of 3-nitropropionic acid-induced neurotoxicity in rats
Serguei Liachenko,Jaivijay Ramu,Merle G. Paule,Joseph Hanig
NeuroToxicology. 2018; 65: 52
[Pubmed] | [DOI]
4 1,2-Dichloroethane-induced toxic encephalopathy: A case series with morphological investigations
Shiyan Chen,Zhijian Zhang,Hong Lin,Zixuan Chen,Zhiqiang Wang,Wei Wang
Journal of the Neurological Sciences. 2015; 351(1-2): 36
[Pubmed] | [DOI]
5 Roles of aquaporins and matrix metalloproteinases in mouse brain edema formation induced by subacute exposure to 1,2-dichloroethane
Gaoyang Wang,Yuan Yuan,Jun Zhang,Lanyue Gao,Xiaoqiong Tan,Guangqian Yang,Xiuqiang Lv,Yaping Jin
Neurotoxicology and Teratology. 2014; 44: 105
[Pubmed] | [DOI]
6 1,2-Dichloroethane-induced toxic leukoencephalopathy with a brain biopsy
Xiaoliang Zhou,Wenbin Zhou,Jinxia Zhou,Lili Long,Bo Xiao
Neurological Sciences. 2014;
[Pubmed] | [DOI]
7 Effects of subacute exposure to 1,2-dichloroethane on mouse behavior and the related mechanisms
G. Wang,Y. Qi,L. Gao,G. Li,X. Lv,Y.P. Jin
Human & Experimental Toxicology. 2013; 32(9): 983
[Pubmed] | [DOI]
8 Pain in the air: Successful computed tomography-guided aspiration in a case of spontaneous pneumorrhachis
Suleman, F.E. and Velleman, M.D.
Spine Journal. 2012; 12(10): 969-970


Print this article  Email this article
Online since 20th March '04
Published by Wolters Kluwer - Medknow