Posterior reversible encephalopathy syndrome: Incidence of atypical regions of involvement and imaging findings
Posterior reversible encephalopathy syndrome: Incidence of atypical regions of involvement and imaging findings
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DOI：
10.2214/ajr.07.2024
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发表时间：
2007-10-01
影响因子：
5
通讯作者：
Teksam, Mehmet
中科院分区：
文献类型：
--
作者：
McKinney, Alexander M.;Short, James;Teksam, Mehmet
目标。后可逆性脑病综合征（PRES）的典型特征是对称的枕顶水肿，但也可能出现在其他影像学表现不同的分布。本研究确定了非典型和典型受累区域的发生率以及不寻常的影像学表现。材料和方法。根据影像学和临床随访结果，从111例最初疑似病例中最终纳入76例确诊PRES患者。两名神经放射学家回顾性地检查了每张MR图像。所有患者的标准序列均为未增强的FLAIR和T1、t2加权图像，大多数患者弥散加权成像（n = 75）和对比增强的T1加权成像（n = 69）。根据FLAIR表现记录受累区域，非典型影像学表现（对比增强、扩散受限、出血）的存在与FLAIR高强度或肿块效应的严重程度（程度）相关。累及部位以顶骨为主，占98.7%；后额叶，78.9%；时间,68.4%;丘脑,30.3%;小脑,34.2%;脑干,18.4%;基底神经节，11.8%。较少见的表现为强化，占37.7%；限制扩散，17.3%；出血,17.1%;还有一种新发现的单侧变异，占2.6%。水肿严重程度与增强（r = 0.072）、扩散受限（r = 0.271）、出血（r = 0.267）、血压（收缩压，r = 0.13；舒张压，r = 0.02）之间相关性较差。潜在的新的PRES原因包括对比剂相关的过敏反应和酒精戒断。这一系列的PRES病例表明，PRES的非典型分布和影像学表现的发生率比通常认为的要高，非典型表现与水肿严重程度的关系并不好。
OBJECTIVE. Posterior reversible encephalopathy syndrome (PRES) is classically characterized as symmetric parietooccipital edema but may occur in other distributions with varying imaging appearances. This study determines the incidence of atypical and typical regions of involvement and unusual imaging manifestations.MATERIALS AND METHODS. Seventy-six patients were eventually included as having confirmed PRES from 111 initially suspected cases, per imaging and clinical follow-up. Two neuroradiologists retrospectively reviewed each MR image. Standard sequences were unenhanced FLAIR and T1- and T2-weighted images in all patients, with diffusion-weighted imaging (n = 75) and contrast-enhanced T1-weighted imaging (n = 69) in most. The regions involved were recorded on the basis of FLAIR findings, and the presence of atypical imaging findings (contrast enhancement, restricted diffusion, hemorrhage) was correlated with the severity (extent) of hyperintensity or mass effect on FLAIR.RESULTS. The incidence of regions of involvement was parietooccipital, 98.7%; posterior frontal, 78.9%; temporal, 68.4%; thalamus, 30.3%; cerebellum, 34.2%; brainstem, 18.4%; and basal ganglia, 11.8%. The incidence of less common manifestations was enhancement, 37.7%; restficted diffusion, 17.3%; hemorrhage, 17.1%; and a newly described unilateral variant, 2.6%. Poor correlation was found between edema severity and enhancement (r = 0.072), restricted diffusion (r = 0.271), hemorrhage (r = 0.267), blood pressure (systolic, r = 0.13; diastolic, r = 0.02). Potentially new PRES causes included contrast-related anaphylaxis and alcohol withdrawal.CONCLUSION. This large series of PRES cases shows that atypical distributions and imaging manifestations of PRES have a higher incidence than commonly perceived, and atypical manifestations do not correlate well with the edema severity.