MRI characteristics of brain edema in preeclampsia/eclampsia patients with posterior reversible encephalopathy syndrome

Hui Mai; Zhiyu Liang; Zhanhang Chen; Zhaoran Liu; Yaxi Xu; Xuting Chen; Xiujian Du; Yuling Peng; Yonglu Chen; Tianfa Dong

doi:10.1186/s12884-021-04145-1

MRI characteristics of brain edema in preeclampsia/eclampsia patients with posterior reversible encephalopathy syndrome

BMC Pregnancy Childbirth. 2021 Oct 3;21(1):669. doi: 10.1186/s12884-021-04145-1.

Authors

Hui Mai^#¹, Zhiyu Liang^#^{1

2}, Zhanhang Chen¹, Zhaoran Liu¹, Yaxi Xu¹, Xuting Chen¹, Xiujian Du¹, Yuling Peng¹, Yonglu Chen¹, Tianfa Dong³

Affiliations

¹ Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, No. 63 Duobao Road, Guangzhou, 510150, China.
² Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou, 510515, China.
³ Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, No. 63 Duobao Road, Guangzhou, 510150, China. 2019683078@gzhmu.edu.cn.

^# Contributed equally.

Abstract

Background: The neuroimaging manifestations of eclampsia and preeclampsia often overlap, mainly presenting as posterior reversible encephalopathy syndrome (PRES). The purpose of this retrospective study was to compare the extent and nature of brain edema in eclampsia and preeclampsia patients with PRES based on MRI characteristics.

Methods: One hundred fifty women diagnosed with preeclampsia-eclampsia and undergoing cranial MRI were enrolled; 24 of these were diagnosed as having eclampsia. According to clinicoradiologic diagnosis of PRES, eligible patients were classified as having eclampsia with PRES (group E-PRES) and preeclampsia with PRES (group P-PRES). A scale on T2W FLAIR-SPIR images was established to evaluate the extent of brain edema, and the score of brain edema (SBE) of both groups was compared. In patients of the two groups who also underwent DWI sequence, the presence or absence of hyperintensity on DWI and hypointensity on ADC maps were determined to compare the nature of brain edema. Furthermore, clinical and biochemical data of the two groups were compared.

Results: The incidence of PRES in eclampsia patients was significantly higher than that in preeclampsia patients (87.50% vs. 46.03%, P<0.001). The SBE of all regions and typical regions in group E-PRES patients were significantly higher than those in group P-PRES patients (15.88±8.72 vs. 10.90±10.21, P=0.021; 8.52±3.87 vs. 5.01±4.19, P=0.002; respectively). The presence of hyperintensity on DWI was determined more frequently in group E-PRES patients than group P-PRES patients (71.43% vs. 32.00%, P=0.024). Age, systolic blood pressure, white blood cell count, neutrophil count and percentage of neutrophils were significantly different between the two groups (P<0.05).

Conclusions: Certain MRI characteristics that reflect the extent and nature of brain edema were different between eclampsia and preeclampsia patients with PRES. Additional prospective studies are still required to explore whether these MRI characteristics of brain edema may further become a potential predictor for eclamptic seizures in preeclampsia patients with PRES.

Keywords: brain edema; eclampsia; magnetic resonance imaging; posterior reversible encephalopathy syndrome; preeclampsia.

MeSH terms

Adult
Brain Edema / diagnostic imaging*
Eclampsia / diagnostic imaging*
Eclampsia / epidemiology
Female
Humans
Magnetic Resonance Imaging*
Neuroimaging*
Posterior Leukoencephalopathy Syndrome / complications
Posterior Leukoencephalopathy Syndrome / diagnostic imaging*
Posterior Leukoencephalopathy Syndrome / epidemiology
Pre-Eclampsia / diagnostic imaging*
Pre-Eclampsia / epidemiology
Pregnancy
Pregnancy Complications / diagnostic imaging*
Pregnancy Complications / epidemiology
Retrospective Studies

Abstract

MeSH terms

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