REVIEWARTICLE Neuroimaging of Diving-Related Decompression Illness: Current Knowledge and Perspectives

SUMMARY: Diving-related decompression illness is classified into 2 main categories: arterial gas embolism and decompression sickness. The latter is further divided into types 1 and 2, depending on the clinical presentation. MR imaging is currently the most accurate neuroimaging technique available for the detection of brain and spinal cord lesions in neurologic type 2 decompression sickness. Rapid bubble formation in tissues and the bloodstream during ascent is the basic pathophysiologic mechanism in decompression illness. These bubbles can damage the central nervous system through different mechanisms, namely arterial occlusion, venous obstruction, or in situ toxicity. Neuroimaging studies of decompression sickness have reported findings associated with each of thesemechanisms: some typical results are summarized and illustrated in this article. We also review the limitations of previous work and make practical methodologic suggestions for future neuroimaging studies. The term “decompression illness ” encompasses all clinicalmanifestations induced by a rapid decrease of environmental pressure, sufficient to cause the formation of inert gas bubbles previously loaded within tissues or blood as a soluble phase. This can occur in various circumstances, including ascent from diving, flying or climbing mountains immediately after a dive, and exer-cising in hyperbaric/hypobaric chambers.1-3 Diving-related de