Evidence mapPaperPMID 39249148Full record

Observational studyPediatric radiology2024

Magnetic resonance imaging patterns and perfusion changes of posterior reversible encephalopathy syndrome in children with clinical outcome correlation.

Smily Sharma, Sarbesh Tiwari, Taruna Yadav, Lokesh Saini, Aliza Mittal, Daisy Khera, Pawan Kumar Garg, Pushpinder Singh Khera

Abstract readObservational Study
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Observational study in Pediatric radiology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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1citing papers in PubMed
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1 · What the graph read from it

What it found

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2 · The registry

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3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

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5 · Who and what money

Authors and funding

8 authors.

Smily SharmaDepartment of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India, 342005.ORCID 0000-0003-3699-0272
Sarbesh TiwariDepartment of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India, 342005. sarbesh1984@gmail.com.ORCID 0000-0003-1661-9070
Taruna YadavDepartment of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India, 342005.ORCID 0000-0002-3644-6093
Lokesh SainiDepartment of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.ORCID 0000-0003-3153-0736
Aliza MittalDepartment of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.ORCID 0000-0002-6404-5406
Daisy KheraDepartment of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.ORCID 0000-0002-2963-1370
Pawan Kumar GargDepartment of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India, 342005.ORCID 0000-0002-5805-1869
Pushpinder Singh KheraDepartment of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India, 342005.ORCID 0000-0002-9714-5462

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPosterior 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.

objectiveWe 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. MATERIALS AND

methodsIn 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).

resultsA 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.

conclusionsThe 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.

Indexed as

Magnetic Resonance ImagingPosterior Leukoencephalopathy SyndromeAdolescentCerebrovascular CirculationChildChild, PreschoolFemaleHumansMaleRetrospective StudiesArterial spin labelingHypertensionPosterior reversible encephalopathy syndromeSeizures

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.