Bartynski W S, Boardman J F
Department of Radiology, Division of Neuroradiology, Presbyterian University Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
AJNR Am J Neuroradiol. 2007 Aug;28(7):1320-7. doi: 10.3174/ajnr.A0549.
Although the term posterior reversible encephalopathy syndrome (PRES) was popularized because of the typical presence of vasogenic edema in the parietal and occipital lobes, other regions of the brain are also frequently affected. We evaluated lesion distribution with CT and MR in a large cohort of patients who experienced PRES to comprehensively assess the imaging patterns identified.
The locations of the PRES lesion at toxicity were comprehensively identified and tabulated in 136 patients by CT (22 patients) and MR (114 patients) imaging including the hemispheric, basal ganglial, and infratentorial locations. Clinical associations along with presentation at toxicity including blood pressure were assessed.
Vasogenic edema was consistently present in the parietal or occipital regions (98%), but other locations were common including the frontal lobes (68%), inferior temporal lobes (40%), and cerebellar hemispheres (30%). Involvement of the basal ganglia (14%), brain stem (13%), and deep white matter (18%) including the splenium (10%) was not rare. Three major patterns of PRES were noted: the holohemispheric watershed (23%), superior frontal sulcal (27%), and dominant parietal-occipital (22%), with additional common partial or asymmetric expression of these primary PRES patterns (28%).
Involvement of the frontal lobe, temporal lobe, and cerebellar hemispheres is common in PRES, along with the occasional presence of lesions in the brain stem, basal ganglia, deep white matter, and splenium. Three primary PRES patterns are noted in the cerebral hemispheres, along with frequent partial or asymmetric expression of these PRES patterns. Awareness of these patterns and variations is important to recognize PRES neurotoxicity more accurately when present.
尽管后部可逆性脑病综合征（PRES）这一术语因顶叶和枕叶典型的血管源性水肿而广为人知，但大脑的其他区域也常受影响。我们对一大群发生PRES的患者进行了CT和MR检查，以评估病变分布，从而全面评估所发现的影像学表现。
通过CT（22例患者）和MR（114例患者）成像，全面确定并列表显示136例患者在出现毒性反应时PRES病变的位置，包括半球、基底节和幕下位置。评估临床关联以及出现毒性反应时的表现，包括血压。
血管源性水肿始终存在于顶叶或枕叶区域（98%），但其他部位也很常见，包括额叶（68%）、颞叶下部（40%）和小脑半球（30%）。基底节（14%）、脑干（13%）和深部白质（18%）包括胼胝体压部（10%）受累并不少见。发现了PRES的三种主要模式：全脑分水岭模式（23%）、额上沟模式（27%）和优势顶枕叶模式（22%），这些主要PRES模式还存在额外常见的部分或不对称表现（28%）。
PRES常见额叶、颞叶和小脑半球受累，偶尔脑干、基底节、深部白质和胼胝体压部也会出现病变。在大脑半球中发现了三种主要的PRES模式，以及这些PRES模式频繁的部分或不对称表现。认识到这些模式和变异对于在出现PRES神经毒性时更准确地识别至关重要。
