title: Imaging characteristics associated with clinical outcomes in posterior reversible encephalopathy syndrome.
abstract: OBJECTIVE
  Posterior reversible encephalopathy syndrome (PRES) is a disorder of cerebrovascular autoregulation that can result in brain edema, hemorrhage, and infarction. We sought to investigate whether certain imaging characteristics in PRES are associated with clinically significant patient outcomes.
  
  
  METHODS
  We retrospectively reviewed all cases of PRES occurring between 2008 and 2014 at two major academic medical centers. Demographic, clinical, and radiographic data were collected. We analyzed imaging studies for vasogenic edema, hemorrhage, and diffusion restriction. We performed univariate analysis and stepwise logistic regression to assess the association between our radiologic findings of interest and clinical outcomes as defined by hospital discharge disposition and modified Rankin scale (mRS) at time of discharge.
  
  
  RESULTS
  We identified 99 cases of PRES in 96 patients. The median age was 55 years (IQR 30-65) and 74% were women. In 99 cases, 60% of patients had active cancer, 19% had history of bone marrow or organ transplantation, 14% had autoimmune disease, and 8% were peripartum. Imaging at clinical presentation showed extensive vasogenic edema in 39%, hemorrhage in 36%, hemorrhage with mass effect in 7%, and restricted diffusion in 16%. In our final logistic regression models, the presence of extensive vasogenic edema, hemorrhage with mass effect, or diffusion restriction was associated with worse clinical outcome as defined by both discharge disposition (OR = 4.3; 95% CI: 1.4-36.3; p = 0.047) and mRS (OR = 3.6; 95% CI: 1.2-10.7; p = 0.019).
  
  
  CONCLUSIONS
  Extensive vasogenic edema, hemorrhage, and restricted diffusion on initial imaging in PRES are associated with worse clinical outcomes.
authors.affiliation: Department of Radiology, Weill Cornell Medicine, 525 E. 68th Street, Box 141, Office: Starr 8A-29, New York, NY, 10065, USA. ans2046@med.cornell.edu.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Schweitzer
authors.affiliation: Department of Neurology, Weill Cornell Medicine, New York, NY, USA.|Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA.
authors.forename: Neal S
authors.initials: NS
authors.lastname: Parikh
authors.affiliation: Department of Healthcare Policy & Research, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY, USA.
authors.forename: Gulce
authors.initials: G
authors.lastname: Askin
authors.affiliation: Department of Radiology, Weill Cornell Medicine, 525 E. 68th Street, Box 141, Office: Starr 8A-29, New York, NY, 10065, USA.
authors.forename: Ajay
authors.initials: A
authors.lastname: Nemade
authors.affiliation: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: John
authors.initials: J
authors.lastname: Lyo
authors.affiliation: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Sasan
authors.initials: S
authors.lastname: Karimi
authors.affiliation: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Knobel
authors.affiliation: Department of Neurology, Weill Cornell Medicine, New York, NY, USA.|Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA.
authors.forename: Babak B
authors.initials: BB
authors.lastname: Navi
authors.affiliation: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Young
authors.affiliation: Department of Radiology, Weill Cornell Medicine, 525 E. 68th Street, Box 141, Office: Starr 8A-29, New York, NY, 10065, USA.|Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA.
authors.forename: Ajay
authors.initials: A
authors.lastname: Gupta
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054038:Posterior Leukoencephalopathy Syndrome / Q000000981:diagnostic imaging* / Q000473:pathology*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Hemorrhage; Ischemia; MRI; PRES; Posterior reversible encephalopathy syndrome; Vasogenic edema