Department of Pediatric Nephrology, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo 183-8561, Japan.
Clin Exp Nephrol. 2011 Apr;15(2):275-80. doi: 10.1007/s10157-010-0380-2. Epub 2010 Dec 10.
Posterior reversible encephalopathy syndrome (PRES) is a reversible, predominantly posterior, leukoencephalopathy associated with renal insufficiency, hypertension, or immunosuppressant drugs. We describe two children with PRES whose primary diagnoses were idiopathic nephrotic syndrome and lupus nephritis. Cranial magnetic resonance (MR) imaging at the onset of PRES showed strong hyperintense signals on diffusion-weighted imaging with restricted apparent diffusion coefficient values predominantly in the posterior region. Such findings have been rarely reported in children with PRES and initially suggested irreversible brain damage; however, both children fully recovered clinically as well as radiologically. Our findings suggest the limitations of cranial MR imaging for diagnosing PRES. Further experience with cranial MR imaging, including diffusion-weighted imaging with apparent diffusion coefficient mapping, is required to improve diagnostic accuracy and the ability to predict outcomes in patients with early-stage PRES. At present, initial imaging studies do not necessarily provide sufficient evidence for a firm diagnosis of PRES or the prediction of outcomes.
后部可逆性脑病综合征（PRES）是一种与肾功能不全、高血压或免疫抑制剂药物相关的可逆转、主要为后部的脑白质病。我们描述了两例 PRES 患儿，其主要诊断为特发性肾病综合征和狼疮性肾炎。PRES 发病时的头颅磁共振成像（MR）显示弥散加权成像上的强高信号，表观弥散系数值受限，主要在后区。在 PRES 患儿中，这种表现很少见，最初提示不可逆性脑损伤；然而，这两个孩子在临床和放射学上都完全恢复了。我们的研究结果提示头颅磁共振成像对 PRES 的诊断存在局限性。需要进一步的头颅磁共振成像经验，包括弥散加权成像与表观弥散系数图，以提高 PRES 患者的诊断准确性和预测能力。目前，初步的影像学研究不一定能为 PRES 的明确诊断或预后预测提供充分的证据。
