Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India, 342005.
Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Pediatr Radiol. 2024 Oct;54(11):1884-1895. doi: 10.1007/s00247-024-06045-w. Epub 2024 Sep 9.
Posterior reversible encephalopathy syndrome (PRES) in children has a propensity towards atypical features on magnetic resonance (MR) imaging, with limited literature on perfusion changes and clinicoradiological correlation.
We aimed to comprehensively study MR imaging patterns of pediatric PRES, including cerebral blood flow variations on arterial spin labeling, and looked for any MR biomarkers of poor clinical outcome.
In this retrospective observational study conducted in a tertiary hospital setting, MR records over a 4-year period (May 2019 to May 2023) were systematically searched along with their clinical details. Patients with an age less than 18 years and a clinicoradiological constellation consistent with PRES were included. MR scans were analyzed by two neuroradiologists with 8 years' and 10 years' experience. Association was sought with poor clinical outcome (defined as modified Rankin Scale score at discharge of > 2).
A total of 45 patients (29 boys) were included in the study, with a mean age (± standard deviation) of 11.19 (± 4.53) years. On MR imaging, 95.6% of patients (n = 43) showed atypical features and/or atypical areas of involvement. The superior frontal sulcus (n = 18) was the most predominant MR pattern, and cerebellar involvement was not uncommon (n = 15). Unilateral involvement (n = 3), isolated central pattern (n = 1), and spinal cord involvement (PRES-SCI: n = 1) were also encountered. Brainstem involvement (n = 4) showed a characteristic "V-sign" of anterior medullary hyperintensity. Patchy restricted diffusion (46.6%), punctate hemorrhages (37.7%), and leptomeningeal contrast enhancement (36%) were not uncommon. Arterial spin labeling sequence (available in 24 patients) showed increased cerebral blood flow in the involved areas in 79.2% of patients. Univariate analysis showed a significant association of the presence of hemorrhage (P = 0.003), involvement of brainstem (P = 0.007), deep white matter (P = 0.008), and thalamus (P = 0.026) with poor clinical outcome. Multivariate regression analysis found that hemorrhage on MRI (P = 0.011, odds ratio 8) was an independent factor associated with poor clinical outcome.
The conventionally described atypical features in PRES are common in children and therefore may no longer be considered exceptions. Raised perfusion on arterial spin labeling sequence was seen in the majority of cases. Hemorrhage on MRI was an independent predictor of poor clinical outcome in pediatric PRES.
儿童后部可逆性脑病综合征（PRES）在磁共振成像（MR）上具有倾向于非典型特征，关于灌注变化和临床放射学相关性的文献有限。
我们旨在全面研究儿科 PRES 的 MR 成像模式，包括动脉自旋标记的脑血流变化，并寻找任何不良临床结局的 MR 生物标志物。
在这项在三级医院进行的回顾性观察性研究中，系统搜索了 4 年期间（2019 年 5 月至 2023 年 5 月）的 MR 记录及其临床详细信息。纳入年龄小于 18 岁且具有 PRES 临床放射学特征的患者。两名具有 8 年和 10 年经验的神经放射科医生对 MR 扫描进行了分析。寻求与不良临床结局（出院时改良 Rankin 量表评分>2）的关联。
共有 45 名患者（29 名男性）纳入研究，平均年龄（±标准差）为 11.19（±4.53）岁。在 MR 成像上，95.6%的患者（n=43）显示非典型特征和/或非典型受累区域。最常见的 MR 模式是额上沟（n=18），小脑受累也不罕见（n=15）。单侧受累（n=3）、孤立的中央模式（n=1）和脊髓受累（PRES-SCI：n=1）也有发现。脑干受累（n=4）表现为前髓质高信号的特征性“V 征”。斑片状弥散受限（46.6%）、点状出血（37.7%）和软脑膜对比增强（36%）也不少见。动脉自旋标记序列（在 24 名患者中可用）显示受累区域的脑血流增加，占 79.2%的患者。单变量分析显示，出血（P=0.003）、脑干受累（P=0.007）、深部白质（P=0.008）和丘脑受累（P=0.026）与不良临床结局显著相关。多变量回归分析发现，MRI 上的出血（P=0.011，优势比 8）是与不良临床结局相关的独立因素。
在儿童中，后部可逆性脑病综合征中通常描述的非典型特征很常见，因此可能不再被视为例外。动脉自旋标记序列上可见多数情况下灌注升高。MRI 上的出血是儿科 PRES 不良临床结局的独立预测因素。
