Utility and Significance of Gadolinium-Based Contrast Enhancement in Posterior Reversible Encephalopathy Syndrome

S.J Karia,L Zhang,A.M Mckinney,J.B Rykken,Z.J Mckinney

doi:10.3174/ajnr.a4563

Abstract

Posterior reversible encephalopathy syndrome is a clinicoradiologic syndrome. Literature regarding associated factors and the prognostic significance of contrast enhancement in posterior reversible encephalopathy syndrome is sparse. This study set out to evaluate an association between the presence of enhancement in posterior reversible encephalopathy syndrome and various clinical factors in a large series of patients with this syndrome. From an MR imaging report search that yielded 176 patients with clinically confirmed posterior reversible encephalopathy syndrome between 1997 and 2014, we identified 135 patients who had received gadolinium-based contrast. The presenting symptoms, etiology, clinical follow-up, and maximum systolic and diastolic blood pressures within 1 day of MR imaging were recorded. MRIs were reviewed for parenchymal hemorrhage, MR imaging severity, and the presence and pattern of contrast enhancement. Statistical analyses evaluated a correlation between any clinical features and the presence or pattern of enhancement. Of 135 included patients (67.4% females; age range, 7-82 years), 59 (43.7%) had contrast enhancement on T1-weighted MR imaging, the most common pattern being leptomeningeal (n = 24, 17.8%) or leptomeningeal plus cortical (n = 21, 15.6%). Clinical outcomes were available in 96 patients. No significant association was found between the presence or pattern of enhancement and any of the variables, including sex, age, symptom, MR imaging severity, blood pressure, or outcome (all P > .05 after Bonferroni correction). The presence or pattern of enhancement in posterior reversible encephalopathy syndrome is not associated with any of the tested variables. However, an association was found between MR imaging severity and clinical outcome.

Highlights

BACKGROUND AND PURPOSEPosterior reversible encephalopathy syndrome is a clinicoradiologic syndrome
Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiographic syndrome that may result from various etiologies but is most commonly associated with hypertension, eclampsia, or treatment with immunosuppressant medications.[1,2,3,4]
The presence of contrast enhancement implies dysfunction of the blood-brain barrier, and it has been postulated that the presence of enhancement in many patients with PRES may further point to endothelial injury as a possible cause.[4,5,6,7,8]

Summary

Methods

From an MR imaging report search that yielded 176 patients with clinically confirmed posterior reversible encephalopathy syndrome between 1997 and 2014, we identified 135 patients who had received gadolinium-based contrast. The presenting symptoms, etiology, clinical follow-up, and maximum systolic and diastolic blood pressures within 1 day of MR imaging were recorded. An MR imaging data base search was conducted for patients in whom the radiologic and clinical features of PRES were present within a 17-year period (1997–2014), yielding 176 patients with clinically confirmed PRES. The radiologic features of PRES were defined by the presence of edema in characteristic distributions, as described previously.[7,9,10] The medical records of these patients were reviewed to retrieve patient demographics and clinical data, including sex, age, primary presenting symptom, presumed etiology, maximum systolic blood pressure (SBPmax) and maximum diastolic blood pressure (DBPmax) (both within 1 day of the MR imaging examination), and clinical outcome (if clinical follow-up was available). The goal was a clinical examination performed at least 60 days after the initial presentation

Results

Discussion

Conclusion