Typical MR Research Articles

Superior lesion detection on 3D FSE T1WI with magnetization transfer and CHESS preparation pulses in children with focal epilepsy: Preliminary results.

In childhood drug-resistant focal epilepsy, the identification of a magnetic resonance imaging lesion significantly affects the management and prognosis, although it is often challenging. Herein we report the preliminary results of a modified MR sequence, in which both magnetization transfer and chemical shift selective preparation pulses are added to a 3D fast spin echo T1-weighted sequence to recognize focal cortical dysplasia. The scan time is short, and the images have expected uniform suppression of the background normal gray and white matter. We report four children with focal epilepsy, in whom the focal cortical and subcortical lesions are superiorly conspicuous on the aforementioned MR sequence compared to the high-resolution fluid-attenuated inversion recovery images obtained with typical epilepsy MR protocols.

Towards retrospective motion correction and reconstruction for clinical 3D brain MRI protocols with a reference contrast

ObjectIn a typical MR session, several contrasts are acquired. Due to the sequential nature of the data acquisition process, the patient may experience some discomfort at some point during the session, and start moving. Hence, it is quite common to have MR sessions where some contrasts are well-resolved, while other contrasts exhibit motion artifacts. Instead of repeating the scans that are corrupted by motion, we introduce a reference-guided retrospective motion correction scheme that takes advantage of the motion-free scans, based on a generalized rigid registration routine.Materials and methodsWe focus on various existing clinical 3D brain protocols at 1.5 Tesla MRI based on Cartesian sampling. Controlled experiments with three healthy volunteers and three levels of motion are performed.ResultsRadiological inspection confirms that the proposed method consistently ameliorates the corrupted scans. Furthermore, for the set of specific motion tests performed in this study, the quality indexes based on PSNR and SSIM shows only a modest decrease in correction quality as a function of motion complexity.DiscussionWhile the results on controlled experiments are positive, future applications to patient data will ultimately clarify whether the proposed correction scheme satisfies the radiological requirements.

Peak Resembling N-acetylaspartate (NAA) on Magnetic Resonance Spectroscopy of Brain Metastases.

Background and Objectives: Differentiating between a high-grade glioma (HGG) and solitary cerebral metastasis presents a challenge when using standard magnetic resonance imaging (MRI) alone. Magnetic resonance spectroscopy (MRS), an advanced MRI technique, may assist in resolving this diagnostic dilemma. N-acetylaspartate (NAA), an amino acid found uniquely in the central nervous system and in high concentrations in neurons, typically suggests HGG over metastatic lesions in spectra from ring-enhancing lesions. This study investigates exceptions to this norm. Materials and Methods: We conducted an MRS study on 49 histologically confirmed and previously untreated patients with brain metastases, employing single-voxel (SVS) techniques with short and long echo times, as well as magnetic resonance spectroscopic imaging (MRSI). Results: In our cohort, 44 out of 49 (90%) patients demonstrated a typical MR spectroscopic profile consistent with secondary deposits: a Cho peak, very low or absent Cr, absence of NAA, and the presence of lipids. A peak at approximately 2 ppm, termed the "NAA-like peak", was present in spectra obtained with both short and long echo times. Among the MRS data from 49 individuals, we observed a peak at 2.0 ppm in five brain metastases from mucinous carcinoma of the breast, mucinous non-small-cell lung adenocarcinoma, two metastatic melanomas, and one metastatic non-small-cell lung cancer. Pathohistological verification of mucin in two of these five cases suggested this peak likely represents N-acetyl glycoproteins, indicative of mucin expression in cancer cells. Conclusions: The identification of a prominent peak at 2.0 ppm could be a valuable diagnostic marker for distinguishing single ring-enhancing lesions, potentially associated with mucin-expressing metastases, offering a new avenue for diagnostic specificity in challenging cases.

Robust EMI elimination for RF shielding-free MRI through deep learning direct MR signal prediction.

To develop a new electromagnetic interference (EMI) elimination strategy for RF shielding-free MRI via active EMI sensing and deep learning direct MR signal prediction (Deep-DSP). Deep-DSP is proposed to directly predict EMI-free MR signals. During scanning, MRI receive coil and EMI sensing coils simultaneously sample data within two windows (i.e., for MR data and EMI characterization data acquisition, respectively). Afterward, a residual U-Net model is trained using synthetic MRI receive coil data and EMI sensing coil data acquired during EMI signal characterization window, to predict EMI-free MR signals from signals acquired by MRI receive and EMI sensing coils. The trained model is then used to directly predict EMI-free MR signals from data acquired by MRI receive and sensing coils during the MR signal-acquisition window. This strategy was evaluated on an ultralow-field 0.055T brain MRI scanner without any RF shielding and a 1.5T whole-body scanner with incomplete RF shielding. Deep-DSP accurately predicted EMI-free MR signals in presence of strong EMI. It outperformed recently developed EDITER and convolutional neural network methods, yielding better EMI elimination and enabling use of few EMI sensing coils. Furthermore, it could work well without dedicated EMI characterization data. Deep-DSP presents an effective EMI elimination strategy that outperforms existing methods, advancing toward truly portable and patient-friendly MRI. It exploits electromagnetic coupling between MRI receive and EMI sensing coils as well as typical MR signal characteristics. Despite its deep learning nature, Deep-DSP framework is computationally simple and efficient.

Evolution of neurodegeneration in patients with normal pressure hydrocephalus: a monocentric follow up study

BackgroundThe aim of this study was to examine in patients with idiopathic and neurodegenerative normal pressure hydrocephalus (NPH) if motor and cognitive performance as well as changes in biomarkers in cerebrospinal fluid (CSF) evolve differently.Methods41 patients with a typical clinical and MR-/CT-morphological presentation of NPH divided into an Alzheimer-negative (AD–, n = 25) and an Alzheimer-positive (AD+, n = 16) group according to neurodegenerative biomarkers (S100 protein, neuron-specific enolase, β-amyloid 1–42, Tau protein, phospho-Tau, protein-level and CSF pressure) in CSF. Follow-up of cognitive and gait functions before and after a spinal tap of 40–50 ml CSF of up to 49 months. Clinical, motor, neuropsychological and CSF biomarkers were analyzed using a repeated multifactorial analysis of variance (ANOVA) with post-hoc testing.ResultsGait and neuropsychological performance and CSF biomarkers evolved differently between the AD− and AD+ patients. In particular, the AD+ patients benefited from the spinal tap regarding short-term memory. In contrast, gait parameters worsened over time in the AD+ patients, although they showed a relevant improvement after the first tap.ConclusionsThe results substantiate the recently reported association between a tap-responsive NPH and CSF changes of Alzheimer disease. Furthermore, they suggest that the AD changes in CSF manifest in an age-related fashion in AD− patients presenting with NPH.

Acute and Chronic Kernicterus: MR Imaging Evolution of Globus Pallidus Signal Change during Childhood.

Despite its rarity in Western countries, kernicterus resulting from severe neonatal hyperbilirubinemia and its associated neurologic consequences still persists. Subtle MR imaging patterns may be overlooked, leading to diagnostic and prognostic uncertainties. The study systematically analyzes MR imaging pattern over time. A retrospective MR imaging study was conducted in Departments of Pediatric Neurology at the University Children's Hospitals in Leipzig, Germany, or Tübingen, Germany, between 2012 and 2022 in patients who presented beyond the neonatal period suspected of having chronic kernicterus. Eight patients with a total of 15 MR images were identified. The clinical diagnosis of kernicterus was confirmed in all cases on the basis of typical MR imaging findings: Bilateral, diffuse hyperintensity of the globus pallidus was observed in the neonatal period on T1WI (1 MR imaging, at 2 weeks), in infancy on T2WI (4 MR images, at 9-26 months). In children 2 years of age and older, bilateral hyperintensity on T2WI was limited to the borders of the globus pallidus (8 MR images, at 20 months -13 years). Notably, 2 children exhibited normal initial MR imaging findings at 2 months of age. Hence, MR imaging depiction of kernicterus pathology evolves with time, first evident on T1WI, subsequently on T2WI, with a "blind window" during early infancy. The T2WI signal change initially involves the entire globus pallidus and later is limited to the borders. Kernicterus had not been diagnosed in any except 2 patients by previous investigators. All patients presented with a characteristic clinical history and signs and an evolving MR imaging pattern. Nonetheless, the diagnosis of kernicterus was frequently missed. Abnormalities on later MR images appear to be underrecognized.

Structured Imaging Approach for Viral Encephalitis.

MR imaging is essential in diagnosing viral encephalitis. Clinical features, cerebrospinal fluid analysis and pathogen confirmation by polymerase chain reaction can be supported by assessing imaging features. MR imaging patterns with typical locations can identify pathogens such as temporal lobe for herpes simplex virus type 1; bilateral thalami for Japanese encephalitis and influenza virus ; and brainstem for enterovirus and rabies. In this article, we have reviewed representative viral encephalitis and its MR imaging patterns. In addition, we also presented acute viral encephalitis without typical MR imaging patterns, such as dengue and varicella-zoster virus encephalitis.

Arteriovenous malformations of the filum terminale: clinical characteristics, angioarchitecture, and management of a rare spinal vascular pathology.

The goal of this study was to describe clinical and neuroradiological features of arteriovenous malformations of the filum terminale (FT AVMs) and to present the authors' diagnostic and therapeutic management in this rare disease. The presented cases were retrieved from a retrospectively collected database of all spinal vascular malformations treated between June 1992 and December 2021 at the Rheinisch-Westfälische Technische Hochschule (RWTH) University Hospital Aachen. Pretreatment and follow-up clinical and neuroradiological data were analyzed for this study. Data in 15 patients with FT AVM with a mean age of 60 years were included, with an overall incidence of FT AVM of 19% among all spinal AVMs in our cohort. Twelve of 15 (80%) patients were men. Nonspecific but typical clinical and MR findings of thoracolumbar congestive myelopathy were found in all patients. Spinal MR angiography, performed in 10 patients, identified in all cases the arterialized FT vein as well as a lumbar/lumbosacral location of an AV shunt. Digital subtraction angiography (DSA) showed an arterial supply solely via the FT artery in 12/15 (80%) patients and via an additional feeder from the lumbosacral region in the other 3/15 (20%) patients. All patients were treated surgically. During 1-year follow-up, 2 patients presented with recurrent FT AVM due to further arterial supply from the lumbosacral region, and were treated surgically. Neurological status was improved in all patients within the 1-year follow-up, with marginal further changes during long-term follow-up. Congestive myelopathy is the major pathological mechanism of symptoms in these patients, with no evidence for intradural bleeding. Missing the presence of possible multiple arterial supply of FT AVM during DSA may result in misdiagnosis and/or insufficient treatment. Due to the frequently prolonged course of FT artery, resection of the FT AVM may be a favorable treatment modality in comparison with endovascular treatment. Follow-up examinations are obligatory within the first 3 years after treatment, and further MR angiography and DSA examinations are indicated if congestive myelopathy persists.

Magnetic resonance imaging of musculoskeletal infections.

Magnetic resonance imaging (MRI) is a powerful imaging modality in the evaluation of musculoskeletal (MSK) soft tissue, joint, and bone infections. It allows prompt diagnosis and assessment of the extent of disease, which permits timely treatment to optimize long-term clinical outcomes. MRI is highly sensitive and specific in detecting the common findings of MSK infections, such as superficial and deep soft tissue oedema, joint, bursal and tendon sheath effusions, lymphadenopathy, bone marrow oedema, erosive bone changes and periostitis, and bone and cartilage destruction and sequestration. Contrast-enhanced MRI allows detection of non-enhancing fluid collections and necrotic tissues, rim-enhancing abscesses, heterogeneously or diffusely enhancing phlegmons, and enhancing active synovitis. Diffusion-weighted imaging (DWI) is useful in detecting soft-tissue abscesses, particularly in patients who cannot receive gadolinium-based intravenous contrast. MRI is less sensitive than computed tomography (CT) in detecting soft-tissue gas. This article describes the pathophysiology of pyogenic MSK infections, including the route of contamination and common causative organisms, typical MR imaging findings of various soft tissue infections including cellulitis, superficial and deep fasciitis and necrotizing fasciitis, pyomyositis, infectious bursitis, infectious tenosynovitis, and infectious lymphadenitis, and of joint and bone infections including septic arthritis and osteomyelitis (acute, subacute, and chronic). The authors also discuss MRI findings and pitfalls related to infected hardware and diabetic foot infections, and briefly review standards of treatment of various pyogenic MSK infections.

Infant and Child MRI: A Review of Scanning Procedures.

Magnetic resonance imaging (MRI) is a safe method to examine human brain. However, a typical MR scan is very sensitive to motion, and it requires the subject to lie still during the acquisition, which is a major challenge for pediatric scans. Consequently, in a clinical setting, sedation or general anesthesia is often used. In the research setting including healthy subjects anesthetics are not recommended for ethical reasons and potential longer-term harm. Here we review the methods used to prepare a child for an MRI scan, but also on the techniques and tools used during the scanning to enable a successful scan. Additionally, we critically evaluate how studies have reported the scanning procedure and success of scanning. We searched articles based on special subject headings from PubMed and identified 86 studies using brain MRI in healthy subjects between 0 and 6 years of age. Scan preparations expectedly depended on subject’s age; infants and young children were scanned asleep after feeding and swaddling and older children were scanned awake. Comparing the efficiency of different procedures was difficult because of the heterogeneous reporting of the used methods and the success rates. Based on this review, we recommend more detailed reporting of scanning procedure to help find out which are the factors affecting the success of scanning. In the long term, this could help the research field to get high quality data, but also the clinical field to reduce the use of anesthetics. Finally, we introduce the protocol used in scanning 2 to 5-week-old infants in the FinnBrain Birth Cohort Study, and tips for calming neonates during the scans.

MR imaging features of multiple biliary hamartomas (Von Meyenburg Complex): A pictorial review and differential diagnosis.

Biliary hamartomas (BHs) are rare malformative cystic/cystic-like lesions of the liver affecting the biliary tree, named after Hanns von Meyenburg who described them for the first time and still known with this eponym to this day. They usually lack clinical symptoms, and abnormalities in liver function tests are unusual; thus, it is typically an incidental finding of liver imaging. Despite being benign lesions, BHs can pose clinical challenges; the first one is differential diagnosis with other more relevant pathological conditions. Therefore, knowledge of MR imaging findings of BHs is helpful for a prompt and correct diagnosis, avoiding unnecessary invasive procedures and/or an excessive number of radiological investigations. This pictorial review is aimed to depict the most typical MR imaging features of multiple biliary hamartomas (von Meyenburg Complex), in order to familiarize the diagnosis and facilitate the differentiation from other hepato-biliary cystic diseases.

Adult Primary Brain Neoplasm, Including 2016 World Health Organization Classification

In 2016, the World Health Organization (WHO) central nervous system (CNS) classification scheme incorporated molecular parameters in addition to traditional microscopic features for the first time. Molecular markers add a level of objectivity that was previously missing for tumor categories heavily dependent on microscopic observation for pathologic diagnosis. This article provides a brief discussion of the major 2016 updates to the WHO CNS classification scheme and reviews typical MR imaging findings of adult primary CNS neoplasms, including diffuse infiltrating gliomas, ependymal tumors, neuronal/glioneuronal tumors, pineal gland tumors, meningiomas, nerve sheath tumors, solitary fibrous tumors, and lymphoma.

Acute Neurological Symptoms After a Liver Transplant

Acute Neurological Symptoms After a Liver Transplant

Accurate MR image super-resolution via lightweight lateral inhibition network

In recent years, convolutional neural networks (CNNs) have shown their advantages on MR image super-resolution (SR) tasks. Many current SR models, however, have heavy demands on computation and memory, which are not friendly to magnetic resonance imaging (MRI) where computing resource is usually constrained. On the other hand, a basic consideration in most MRI experiments is how to reduce scanning time to improve patient comfort and reduce motion artifacts. In this work, we ease the problem by presenting an effective and lightweight model that supports fast training and accurate SR inference. The proposed network is inspired by the lateral inhibition mechanism, which assumes that there exist inhibitory effects between adjacent neurons. The backbone of our network consists of several lateral inhibition blocks, where the inhibitory effect is explicitly implemented by a battery of cascaded local inhibition units. When model scale is small, explicitly inhibiting feature activations is expected to further explore model representational capacity. For more effective feature extraction, several parallel dilated convolutions are also used to extract shallow features directly from the input image. Extensive experiments on typical MR images demonstrate that our lateral inhibition network (LIN) achieves better SR performance than other lightweight models with similar model scale.

Quantitative identification and segmentation repeatability of thoracic spinal muscle morphology.

ObjectiveMRI derived spinal‐muscle morphology measurements have potential diagnostic, prognostic, and therapeutic applications in spinal health. Muscle morphology in the thoracic spine is an important determinant of kyphosis severity in older adults. However, the literature on quantification of spinal muscles to date has been limited to cervical and lumbar regions. Hence, we aim to propose a method to quantitatively identify regions of interest of thoracic spinal muscle in axial MR images and investigate the repeatability of their measurements.MethodsMiddle (T4‐T5) and lower (T8‐T9) thoracic levels of six healthy volunteers (age 26 ± 6 years) were imaged in an upright open scanner (0.5T MROpen, Paramed, Genoa, Italy). A descriptive methodology for defining the regions of interest of trapezius, erector spinae, and transversospinalis in axial MR images was developed. The guidelines for segmentation are laid out based on the points of origin and insertion, probable size, shape, and the position of the muscle groups relative to other recognizable anatomical landmarks as seen from typical axial MR images. 2D parameters such as muscle cross‐sectional area (CSA) and muscle position (radius and angle) with respect to the vertebral body centroid were computed and 3D muscle geometries were generated. Intra and inter‐rater segmentation repeatability was assessed with intraclass correlation coefficient (ICC (3,1)) for 2D parameters and with dice coefficient (DC) for 3D parameters.ResultsIntra and inter‐rater repeatability for 2D and 3D parameters for all muscles was generally good/excellent (average ICC (3,1) = 0.9 with ranges of 0.56‐0.98; average DC = 0.92 with ranges from 0.85‐0.95).ConclusionThe guidelines proposed are important for reliable MRI‐based measurements and allow meaningful comparisons of muscle morphometry in the thoracic spine across different studies globally. Good segmentation repeatability suggests we can further investigate the effect of posture and spinal curvature on muscle morphology in the thoracic spine.

Combination of Imaging Features and Clinical Biomarkers Predicts Positive Pathology and Microbiology Findings Suggestive of Spondylodiscitis in Patients Undergoing Image-Guided Percutaneous Biopsy.

Pathology and microbiology results for suspected spondylodiscitis on MR imaging are often negative in up to 70% of cases. We aimed to predict whether MR imaging features will add diagnostic value when combined with clinical biomarkers to predict positive findings of spondylodiscitis on pathology and/or microbiology from percutaneous biopsy. In this retrospective single-center institutional review board-approved study, patients with radiologically suspected spondylodiscitis and having undergone percutaneous biopsies were assessed. Demographic characteristics, laboratory values, and tissue and blood cultures were collected. Pathology and microbiology results were used as end points. Three independent observers provided MR imaging-based scoring for typical MR imaging features for spondylodiscitis. Multivariate logistic regression and receiver operating characteristic analysis were performed to determine an optimal combination of imaging and clinical biomarkers in predicting positive findings on pathology and/or microbiology from percutaneous biopsy suggestive of spondylodiscitis. Our patient cohort consisted of 72 patients, of whom 33.3% (24/72) had spondylodiscitis. The mean age was 63 ± 16 years with a male/female ratio of 41:31. Logistic regression revealed a combination with an area under the curve of 0.72 for pathology and 0.68 for pathology and/or microbiology. Epidural enhancement on MR imaging improved predictive performance to 0.87 for pathology and 0.78 for pathology and/or microbiology. Our findings demonstrate that epidural enhancement on MR imaging added diagnostic value when combined with clinical biomarkers to help predict which patients undergoing percutaneous biopsy will have positive findings for spondylodiscitis on pathology and/or microbiology.

Volumetric Estimation of the Damaged Area in the Human Brain from 2D MR Image

In this article, we present a volumetric estimate of the mutilated part in the human brain from a typical 2D MR image that is directly rendered from the scanner, which is first of its kind in the field of medical imaging. The proposed concept necessitates segmentation of the MR image for the identification of dimensions in the damaged region. Once the dimensions are identified from the resultant segmented image, the volume of the damaged region is evaluated through the Gauss Derivation theorem. The pixel to the distance scaling, which is fed as an input for the Gauss Derivation is from an earlier medical diagnosis from another researcher. The proposed algorithm was experimented with real-time images and the obtained results were examined against the real-time scenarios and were observed to exhibit better accuracy.

Initial assessment of 3D magnetic resonance fingerprinting (MRF) towards quantitative brain imaging for radiation therapy.

Magnetic resonance fingerprinting (MRF) provides quantitative T1/T2 maps, enabling applications in clinical radiotherapy such as large-scale, multi-center clinical trials for longitudinal assessment of therapy response. We evaluated the feasibility of a quantitative three-dimensional-MRF (3D-MRF) towards its radiotherapy applications of primary brain tumors. A fast whole-brain 3D-MRF sequence initially developed for diagnostic radiology was optimized using flexible body coils, which is the typical MR imaging setup for radiotherapy treatment planning and for MR imaging (MRI)-guided treatment delivery. Optimization criteria included the accuracy and the precision of T1/T2 quantifications of polyvinylpyrrolidone (PVP) solutions, compared to those from the 3D-MRF using a 32-channel head coil. The accuracy of T1/T2 quantifications from the optimized MRF was first examined in healthy volunteers with two different coil setups. The intra- and inter-scanner variations of image intensity from the optimized sequence were quantified by longitudinal scans of the PVP solutions on two 3T scanners. Using a 3D-printed MRI geometry phantom, susceptibility-induced distortion with the optimized 3D-MRF was quantified as the Dice coefficient of phantom contours, compared to those from CT images. By introducing intentional head motion during 10% of the scan, the robustness of the optimized 3D-MRF towards motion was evaluated through visual inspection of motion artifacts and through quantitative analysis of image sharpness in brain MRF maps. The optimized sequence acquired whole-brain T1, T2 and proton density maps and with a resolution of 1.2×1.2×3mm3 in 10min, similar to the total acquisition time of 3D T1- and T2-weighted images of the same resolution. In vivo T1 and T2 values of the white and gray matter were consistent with literature. The intra- and inter-scanner variability of the intensity-normalized MRF T1 was 1.0%±0.7% and 2.3%±1.0% respectively, in contrast to 5.3%±3.8% and 3.2%±1.6% from the normalized T1-weighted MRI. Repeatability and reproducibility of MRF T1 were independent of intensity normalization. Both phantom and human data demonstrated that the optimized 3D-MRF is more robust to subject motion and artifacts from subject-specific susceptibility difference. Compared to CT contours, the Dice coefficient of phantom contours from 3D-MRF was 0.93, improved from 0.87 from the T1-weighted MRI. Compared to conventional MRI, the optimized 3D-MRF demonstrated improved repeatability across time points and reproducibility across scanners for better tissue quantification, as well as improved robustness to subject-specific susceptibility and motion artifacts under a typical MR imaging setup for radiotherapy. More importantly, quantitative MRF T1/T2 measurements lead to promising potentials towards longitudinal quantitative assessment of treatment response for better adaptive therapy and for large-scale, multi-center clinical trials.

Reduction of vibration‐induced signal loss by matching mechanical vibrational states: Application in high b‐value diffusion‐weighted MRS

Diffusion encoding gradients are known to yield vibrations of the typical clinical MR scanner hardware with a frequency of 20 to 30 Hz, which may lead to signal loss in diffusion-weighted MR measurements. This work proposes to mitigate vibration-induced signal loss by introducing a vibration-matching gradient (VMG) to match vibrational states during the 2 diffusion gradient pulses. A theoretical description of displacements induced by gradient switching was introduced and modeled by a 2-mass-spring-damper system. An additional preceding VMG mimicking timing and properties of the diffusion encoding gradients was added to a high b-value diffusion-weighted MR spectroscopy sequence. Laser interferometry was employed to measure 3D displacements of a phantom surface. Lipid ADC was assessed in water-fat phantoms and in vivo in the tibial bone marrow of 3 volunteers. The modeling and the laser interferometer measurements revealed that the displacement curves are more similar during the 2 diffusion gradients with the VMG compared to the standard sequence, resulting in less signal loss of the diffusion-weighted signal. Phantom results showed lipid ADC overestimation up to 119% with the standard sequence and an error of 5.5% with the VMG. An 18% to 35% lower coefficient of variation was obtained for in vivo lipid ADC measurement when employing the VMG. The application of the VMG reduces the signal loss introduced by hardware vibrations in a high b-value diffusion-weighted MRS sequence in phantoms and in vivo. Reference measurements based on laser interferometry and mechanical modelling confirmed the findings.

Posterior reversible encephalopathy syndrome (PRES): Is DWI a prognosis factor?

IntroductionPosterior reversible encephalopathy syndrome is a clinicoradiologic entity with typical MR imaging showing a white matter vasogenic edema predominantly affecting the occipital and parietal lobes of the brain. The aim of this article is evaluated the importance of DWI as a prognosis factor in patients with PRES. Materials and methodsWe reviewed data from 70 patients with PRES (35 with restricted DWI and 35 with no DWI abnormalities), that were admitted to Hospital São Lucas-PUCRS. These two groups were evaluated in age, sex, previous diseases and past medical history, use of medications, the neurologic manifestations, the highest blood pressure during the neurologic presentation and the highest creatinine during the period of observation. ResultsEvaluating 70 patients with PRES with a mean age of 25.4 years old (range from 2 to 74 years old; 55 female and 15 male) we identified 35 cases were brain MRI presents with restricted DWI. Restricted DWI was associated with higher mortality in 90 days (14.2% vs 0.0%; p: 0.027). ConclusionsFew articles present new data that will help clinicians in therapeutic decisions or that modify the knowledge of this syndrome. We suggested that restricted DWI is associated with a worst prognosis in PRES.