Diagnosis of posterior reversible encephalopathy syndrome after kidney transplantation by MRI:a report of 4 cases

Abstract

Objective To investigate the application of MRI in the diagnosis of posterior reversible encephalopathy syndrome(PRES)after kidney transplant.Methods All 4 patients with PRES after kidney transplants were female,with mean age of 41.7 years.Ciclosporin A(or tacrolimus),mycophenolate mofetil and glucocorticoids were used for preventing reject reaction in all patients after kidney transplant,and anti-lymphocyte globulin was used on the second day after operation in one case.Onset time of PRES was 7-10 days(mean 10 days),and MRl was performed in 2 d after onset.Results MRI showed that parietal lobe was involved in 4 cases,occipital lobe in 3 cases,frontal lobe in 2 cases,cerebellum in 2 cases,pons in one case,and basal nucleus in one case.There was no obvious space-occupying effect in lesions.The lesions in the occipital,parietal lobes and frontal lobe were situated in subcortical white,one of which cortex was involved.MRI showed that the lesions were distributed with plaque shape and bilaterally symmetry.The lesions were hypo-,isointense on T1 weighted.and hyperintense on T2 weighted and fluid-attenuated inversion recovery (FLAIR)imaging,respectively.On diffusion-weighted imaging(DWI),the lesions appeared as isointense in 3 cases and hypointense in one case.On apparent diffusion coefficient(ADC)map,all of the lesions were hyperintense.The surrounding of the lesion in one case was hyperintense in DWI,and isointense in ADC map.Conclusion PRES after kidney transplant has characteristic MR findings,especially on DWI and ADC map,which is helpful for us to make the early diagnosis of PRES. Key words: Brain diseases; Brain edema; Parietal lobe; Occipital lobe; Magnetic resonance imaging; Kidney transplantation