Vanacker Peter, Matias Gonçalo, Hagmann Patric, Michel Patrik
Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Department of Neurology, University Hospital Antwerp, Edegem, Belgium.
J Neuroimaging. 2015 Jul-Aug;25(4):643-6. doi: 10.1111/jon.12158. Epub 2014 Sep 25.
PRES is a reversible neurotoxic state presenting with headache, altered mental status, visual loss, and seizures. Delayed diagnosis can be avoided if radiological patterns could distinguish PRES from cerebral ischemia.
Clinical and radiological data were collected on all hospitalized patients who had (1) discharge diagnosis of PRES and (2) acute CTP/CTA. Data were compared with 10 TIA patients with proven cytotoxic edema on MRI.
Of the four PRES patients found, three were correlated with acute blood pressure and one with chemotherapy. At the radiological level, quantitative analyses of the CTP parameters showed that 2 out of 4 patients had bilaterally reduced CBF-values (23.2-47.1 ml/100g/min) in occipital regions, as seen in the pathological regions of TIA patients (27.3 ± 13.5 ml/100g/min). When compared with TIA patients, the pathological ROI's demonstrated decreased CBV-values (3.4-5.6 ml/100g). Vasogenic edema on MRI FLAIR imaging was seen in only one PRES patient, and cytotoxic edema on DWI-imaging was never found. CT angiography showed in one PRES patient a vasospasm-like unilateral posterior cerebral artery.
If confirmed by other groups, CTP and CTA imaging in patients with acute visual loss and confusion may help to distinguish PRES from bi-occipital ischemia. These radiological parameters may identify PRES patients at risk for additional tissue infarction.
后部可逆性脑病综合征（PRES）是一种可逆的神经毒性状态，表现为头痛、精神状态改变、视力丧失和癫痫发作。如果放射学模式能够将PRES与脑缺血区分开来，就可以避免延迟诊断。
收集所有住院患者的临床和放射学数据，这些患者具有（1）PRES的出院诊断和（2）急性CT灌注成像（CTP）/CT血管造影（CTA）。将数据与10例经MRI证实有细胞毒性水肿的短暂性脑缺血发作（TIA）患者进行比较。
在发现的4例PRES患者中，3例与急性血压相关，1例与化疗相关。在放射学层面，CTP参数的定量分析显示，4例患者中有2例枕叶区域双侧脑血流量（CBF）值降低（23.2 - 47.1 ml/100g/min），这与TIA患者的病理区域所见情况（27.3 ± 13.5 ml/100g/min）相似。与TIA患者相比，病变感兴趣区（ROI）的脑血容量（CBV）值降低（3.4 - 5.6 ml/100g）。MRI液体衰减反转恢复序列（FLAIR）成像仅在1例PRES患者中发现血管源性水肿，弥散加权成像（DWI）上从未发现细胞毒性水肿。CT血管造影显示1例PRES患者有类似血管痉挛的单侧大脑后动脉。
如果其他研究组证实，对于急性视力丧失和意识模糊的患者，CTP和CTA成像可能有助于将PRES与双侧枕叶缺血区分开来。这些放射学参数可能识别出有额外组织梗死风险的PRES患者。
