Diffusion imaging may predict reversible brain lesions in eclampsia and severe preeclampsia: initial experience.
OBJECTIVE
The purpose of this study was to validate diffusion-weighted magnetic resonance imaging in the prediction of the evolutive course of brain edema and to establish its pathophysiologic presence in patients with eclampsia/severe preeclampsia.


METHODS
Seventeen patients with a clinical diagnosis of severe eclampsia/preeclampsia and T2 hyperintense brain lesions on routine magnetic resonance imaging were evaluated at hospital admission and 8 weeks later.


RESULTS
Brain edema was reversible in 13 patients and irreversible in 4 patients, as indicated on follow-up magnetic resonance imaging. Sixteen of 17 patients were differentiated accurately into reversible and irreversible groups on the basis of diffusion imaging on hospital admission. Diffusion-weighted magnetic resonance imaging demonstrated a significant increase in water mobility in abnormal regions compared with normal-appearing brains in patients in the reversible group (1.34+/-0.10 mm(2) vs 0.79+/-0.08 mm(2)/s x 10(-3), P<.001). In the irreversible group, restricted water diffusion was present, which was consistent with cytotoxic edema and early brain infarction in 3 of 4 patients.


CONCLUSIONS
Diffusion-weighted magnetic resonance imaging can predict successfully the evolutive course of brain edema in an acute setting in these patients. Our findings indicate that brain edema is vasogenic, although ischemic/cytotoxic edema was observed less commonly.
Loureiro
Ricardo
R
Department of Radiology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil. rlradiol@bol.com.br
Leite
Claudia C
CC
Kahhale
Soubhi
S
Freire
Sálvio
S
Sousa
Benesson
B
Cardoso
Ellison F
EF
Alves
Eliane A
EA
Borba
Paulo
P
Cerri
Giovanni G
GG
Zugaib
Marcelo
M
D000293:Adolescent; D000328:Adult; D001921:Brain / Q000473:pathology* / Q000503:physiopathology*; D001929:Brain Edema / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D038524:Diffusion Magnetic Resonance Imaging; D004461:Eclampsia / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D011225:Pre-Eclampsia / Q000150:complications / Q000175:diagnosis*; D011247:Pregnancy; D011379:Prognosis; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index