Schweitzer Andrew D, Parikh Neal S, Askin Gulce, Nemade Ajay, Lyo John, Karimi Sasan, Knobel Anna, Navi Babak B, Young Robert J, Gupta Ajay
Department of Radiology, Weill Cornell Medicine, 525 E. 68th Street, Box 141, Office: Starr 8A-29, New York, NY, 10065, USA.
Department of Neurology, Weill Cornell Medicine, New York, NY, USA.
Neuroradiology. 2017 Apr;59(4):379-386. doi: 10.1007/s00234-017-1815-1. Epub 2017 Mar 13.
Posterior reversible encephalopathy syndrome (PRES) is a disorder of cerebrovascular autoregulation that can result in brain edema, hemorrhage, and infarction. We sought to investigate whether certain imaging characteristics in PRES are associated with clinically significant patient outcomes.
We retrospectively reviewed all cases of PRES occurring between 2008 and 2014 at two major academic medical centers. Demographic, clinical, and radiographic data were collected. We analyzed imaging studies for vasogenic edema, hemorrhage, and diffusion restriction. We performed univariate analysis and stepwise logistic regression to assess the association between our radiologic findings of interest and clinical outcomes as defined by hospital discharge disposition and modified Rankin scale (mRS) at time of discharge.
We identified 99 cases of PRES in 96 patients. The median age was 55 years (IQR 30-65) and 74% were women. In 99 cases, 60% of patients had active cancer, 19% had history of bone marrow or organ transplantation, 14% had autoimmune disease, and 8% were peripartum. Imaging at clinical presentation showed extensive vasogenic edema in 39%, hemorrhage in 36%, hemorrhage with mass effect in 7%, and restricted diffusion in 16%. In our final logistic regression models, the presence of extensive vasogenic edema, hemorrhage with mass effect, or diffusion restriction was associated with worse clinical outcome as defined by both discharge disposition (OR = 4.3; 95% CI: 1.4-36.3; p = 0.047) and mRS (OR = 3.6; 95% CI: 1.2-10.7; p = 0.019).
Extensive vasogenic edema, hemorrhage, and restricted diffusion on initial imaging in PRES are associated with worse clinical outcomes.
后部可逆性脑病综合征（PRES）是一种脑血管自动调节功能障碍性疾病，可导致脑水肿、出血和梗死。我们试图研究PRES的某些影像学特征是否与具有临床意义的患者预后相关。
我们回顾性分析了2008年至2014年间在两家大型学术医疗中心发生的所有PRES病例。收集了人口统计学、临床和影像学数据。我们分析了影像学研究中的血管源性水肿、出血和弥散受限情况。我们进行了单因素分析和逐步逻辑回归，以评估我们感兴趣的影像学发现与出院时医院出院处置和改良Rankin量表（mRS）所定义的临床结局之间的关联。
我们在96例患者中识别出99例PRES病例。中位年龄为55岁（四分位间距30 - 65岁），74%为女性。在99例病例中，60%的患者患有活动性癌症，19%有骨髓或器官移植史，14%有自身免疫性疾病，8%为围产期患者。临床表现时的影像学检查显示，39%有广泛的血管源性水肿，36%有出血，7%有伴有占位效应的出血，16%有弥散受限。在我们最终的逻辑回归模型中，广泛的血管源性水肿、伴有占位效应的出血或弥散受限与出院处置（OR = 4.3；95%CI：1.4 - 36.3；p = 0.047）和mRS（OR = 3.6；95%CI：1.2 - 10.7；p = 0.019）所定义的更差临床结局相关。
PRES初始影像学检查中的广泛血管源性水肿、出血和弥散受限与更差的临床结局相关。
