title: Cytotoxic Edema in Posterior Reversible Encephalopathy Syndrome: Correlation of MRI Features with Serum Albumin Levels.
abstract: OBJECTIVE
  Posterior reversible encephalopathy syndrome is a clinicoradiologic entity with typical MR imaging showing predominant vasogenic and occasional cytotoxic edema. It is unclear whether MR imaging correlates with levels of serum albumin. We determined potential risk factors for development of cytotoxic edema in posterior reversible encephalopathy syndrome.
  
  
  METHODS
  Seventy-nine cases with typical clinical symptoms and characteristic neuroradiologic findings conformed to posterior reversible encephalopathy syndrome diagnostic criteria and were included in this study. FLAIR, DWI, and ADC maps were interpreted to evaluate the severity and type of edema. MR imaging was correlated with the levels of serum albumin, and cytotoxic edema was compared with the location and severity of brain edema.
  
  
  RESULTS
  Pure vasogenic edema was found in 53 cases (67.09%), and vasogenic edema complicated with cytotoxic components, in 26 patients (32.91%). There was no difference in serum albumin levels between patients with cytotoxic components and those with vasogenic edema (P = .983). There was a significant difference in the edema scale scores between patients with cytotoxic edema and those with vasogenic edema (P = .006). The percentage of cytotoxic edema located in the area with higher scale scores of edema was significantly larger than that in areas with lower scale scores of edema (P = .002).
  
  
  CONCLUSIONS
  Serum albumin may contribute to the development of edema in PRES but is not a decisive factor for edema type. Cytotoxic edema in posterior reversible encephalopathy syndrome is probably related to regional decreased perfusion and arteriolopathy. Further work should be undertaken to discover the pathophysiologic mechanisms involved.
authors.affiliation: From the Department of Radiology (B.G., B.X.Y., R.S.L., G.Z., H.Z.X., F.L.L.), Yantai Yuhuangding Hospital, Qingdao University, Shandong Province, China Department of Radiology (B.G.), Zhongda Hospital, Southeast University, Nanjing, China.
authors.forename: B
authors.initials: B
authors.lastname: Gao
authors.affiliation: From the Department of Radiology (B.G., B.X.Y., R.S.L., G.Z., H.Z.X., F.L.L.), Yantai Yuhuangding Hospital, Qingdao University, Shandong Province, China.
authors.forename: B X
authors.initials: BX
authors.lastname: Yu
authors.affiliation: From the Department of Radiology (B.G., B.X.Y., R.S.L., G.Z., H.Z.X., F.L.L.), Yantai Yuhuangding Hospital, Qingdao University, Shandong Province, China.
authors.forename: R S
authors.initials: RS
authors.lastname: Li
authors.affiliation: From the Department of Radiology (B.G., B.X.Y., R.S.L., G.Z., H.Z.X., F.L.L.), Yantai Yuhuangding Hospital, Qingdao University, Shandong Province, China.
authors.forename: G
authors.initials: G
authors.lastname: Zhang
authors.affiliation: From the Department of Radiology (B.G., B.X.Y., R.S.L., G.Z., H.Z.X., F.L.L.), Yantai Yuhuangding Hospital, Qingdao University, Shandong Province, China.
authors.forename: H Z
authors.initials: HZ
authors.lastname: Xie
authors.affiliation: From the Department of Radiology (B.G., B.X.Y., R.S.L., G.Z., H.Z.X., F.L.L.), Yantai Yuhuangding Hospital, Qingdao University, Shandong Province, China.
authors.forename: F L
authors.initials: FL
authors.lastname: Liu
authors.affiliation: Department of Neurology (C.L.), Yantai City Yantaishan Hospital and Yantai Sino-France Friendship Hospital, Shandong Province, China. ytbrian@126.com.
authors.forename: C
authors.initials: C
authors.lastname: Lv
mesh_terms: D000328:Adult; D001929:Brain Edema / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D054038:Posterior Leukoencephalopathy Syndrome / Q000175:diagnosis*; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis*; D013223:Statistics as Topic; D013577:Syndrome
chemical_list: D012709:Serum Albumin