Andrew C. McClelland, Colin A. Ellis, Emory Kuo, Kenny Q. Ye, Ramani Balu, Suyash Mohan
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引用次数: 0
摘要
背景与目的后路可逆性脑病综合征(PRES)是一种具有特征性影像学表现的神经毒性状态。典型的PRES通常包括顶枕水肿,非典型病例表现为不同程度的深灰色核、脑干、小脑和胼胝体受累,这可能使诊断复杂化。本研究旨在在一个大队列中描述“非典型”PRES的神经影像学特征,并评估其与临床变量和结果的关系。方法回顾性分析PRES患者的神经影像学资料,确定非典型水肿的病例。通过单变量和多变量回归分析评估MRI表现、临床变量和结果之间的关系。结果共分析了184例PRES病例。71.7%有“非典型”影像学表现。非典型水肿与年龄较大相关(比值比[OR] 2.96≥52岁,p = 0.002),与妊娠负相关(比值比[OR] 0.20, p = 0.001)。这些关联见于非典型部位的一个子集,特别是由后循环供应的部位。此外,某些非典型水肿模式与住院时间延长和临床可逆性降低相关,表明对患者预后有潜在影响。结论在这一系列的PRES病例中,不典型的影像学表现是常见的。非典型水肿,包括后循环模式,在老年患者中更常见,在妊娠患者中较少见,并且可能代表该综合征的更严重形式,预后更差。认识到这些非典型影像模式对于及时干预和改善患者预后至关重要。
Atypical Edema in Posterior Reversible Encephalopathy Syndrome: Clinical Associations and Outcome
Background and Purpose
Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic state with characteristic imaging findings. While classic PRES typically involves parieto-occipital edema, atypical cases present with variable involvement of deep gray nuclei, brainstem, cerebellum, and corpus callosum, which may complicate diagnosis. This study aims to characterize the neuroimaging features of “atypical” PRES in a large cohort and evaluate relationships with clinical variables and outcomes.
Methods
We retrospectively analyzed neuroimaging data from patients diagnosed with PRES, identifying cases with atypical edema patterns. Relationships between MRI findings, clinical variables, and outcomes were assessed with univariable and multivariable regression analyses.
Results
A total of 184 PRES cases were analyzed. 71.7% had “atypical” imaging findings. Atypical edema was associated with older age (odds ratio [OR] 2.96 ≥52 years, p = 0.002) and negatively associated with pregnancy (OR 0.20, p<0.001). These associations were seen in a subset of atypical locations, particularly those supplied by the posterior circulation. Additionally, certain atypical edema patterns were correlated with prolonged hospital stays and reduced clinical reversibility, suggesting a potential impact on patient outcomes.
Conclusion
In this large series of PRES cases, atypical imaging findings were common. Atypical edema, including a posterior circulation pattern, was seen more commonly in older patients, less commonly in pregnancy, and may represent a more severe form of this syndrome with worse outcomes. Recognizing these atypical imaging patterns is crucial for timely intervention and improved patient outcomes.
期刊介绍:
Start reading the Journal of Neuroimaging to learn the latest neurological imaging techniques. The peer-reviewed research is written in a practical clinical context, giving you the information you need on:
MRI
CT
Carotid Ultrasound and TCD
SPECT
PET
Endovascular Surgical Neuroradiology
Functional MRI
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and other new and upcoming neuroscientific modalities.The Journal of Neuroimaging addresses the full spectrum of human nervous system disease, including stroke, neoplasia, degenerating and demyelinating disease, epilepsy, tumors, lesions, infectious disease, cerebral vascular arterial diseases, toxic-metabolic disease, psychoses, dementias, heredo-familial disease, and trauma.Offering original research, review articles, case reports, neuroimaging CPCs, and evaluations of instruments and technology relevant to the nervous system, the Journal of Neuroimaging focuses on useful clinical developments and applications, tested techniques and interpretations, patient care, diagnostics, and therapeutics. Start reading today!