Posterior reversible encephalopathy syndrome: utility of fluid-attenuated inversion recovery MR imaging in the detection of cortical and subcortical lesions.
Posterior reversible encephalopathy syndrome: utility of fluid-attenuated inversion recovery MR imaging in the detection of cortical and subcortical lesions.
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发表时间：
2000-06
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通讯作者：
S. Casey;R. Sampaio;E. Michel;C. Truwit
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作者：
S. Casey;R. Sampaio;E. Michel;C. Truwit
背景和目的后部可逆性脑病综合征(PreS)以头痛、精神功能改变、癫痫发作和视力丧失为典型特征，其影像表现为双侧皮质下和皮质下水肿，主要分布在后部。我们的目标是确定与常规MR技术相比，液体衰减反转恢复(FLAIR)成像是否提高了发现PRES细微周围病变的能力。方法对16例临床和影像表现符合PRES的患者进行研究。13例患者接受了环孢菌素A神经毒性的移植。将FAST-FLAIR图像与自旋回波质子密度和T2加权图像进行比较。结果FLAIR成像提高了PRES T2高信号病变的诊断置信度和显着性，尤其是双侧顶枕区皮质下白质。在所有23项异常的MR研究中，FLAIR在检测幕上脑中的PRES方面被认为优于质子密度和T2加权图像。在23项研究中的平均6.7项中，FLAIR的发现促进了疾病严重程度的提高。FLAIR还显示94%的PRES患者皮质受累，平均占总病变负担的46%。在四个病例中，如果没有FLAIR，几乎无法检测到细微的病变。56%的患者出现脑干或小脑疾病。结论与质子密度和T2加权自旋回波成像相比，FLAIR增强了对PRES皮质下和皮质病变的诊断和发现能力。因此，我们认为应该对可疑的PRES患者进行FLAIR检查，以便更有信心地识别通常微妙的影像异常。
BACKGROUND AND PURPOSE Posterior reversible encephalopathy syndrome (PRES) is typically characterized by headache, altered mental functioning, seizures, and visual loss associated with imaging findings of bilateral subcortical and cortical edema with a predominantly posterior distribution. Our goal was to determine whether fluid-attenuated inversion recovery (FLAIR) imaging improves the ability to detect subtle peripheral lesions of PRES, as compared with conventional MR techniques. METHODS Sixteen patients with clinical and imaging findings consistent with PRES were studied. Thirteen patients had undergone transplantation and had cyclosporin A neurotoxicity. Fast-FLAIR images were compared with spin-echo proton density- and T2-weighted images. RESULTS FLAIR imaging improved diagnostic confidence and conspicuity of the T2 hyperintense lesions of PRES, typically in the subcortical white matter of the parietooccipital regions bilaterally. On all 23 abnormal MR studies, FLAIR was judged superior to proton density- and T2-weighted images for the detection of PRES in the supratentorial brain. In a mean of 6.7 of 23 studies, FLAIR findings prompted a raise in the grade of disease severity. FLAIR also showed cortical involvement in 94% of patients with PRES and in a mean of 46% of the total lesion burden. In four cases, subtle lesions were virtually undetectable without FLAIR. Brain stem or cerebellar disease was encountered in 56% of patients. CONCLUSION FLAIR improves the ability to diagnose and detect subcortical and cortical lesions in PRES as compared with proton density- and T2-weighted spin-echo images. We therefore believe that FLAIR should be performed in patients with suspected PRES to allow more confident recognition of the often subtle imaging abnormalities.