Imaging characteristics associated with clinical outcomes in posterior reversible encephalopathy syndrome.

PURPOSE: 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.

West Nile Virus Central Nervous System Infection in Patients Treated With Rituximab: Implications for Diagnosis and Prognosis, With a Review of Literature.

The spectrum of West Nile virus (WNV) infection continues to be elucidated. Many cases of WNV are asymptomatic; however, in immunocompromised patients, symptoms are more likely to be severe. We describe fatal WNV central nervous system disease in lymphoma patients who received rituximab, blunting the inflammatory response and complicating diagnosis.

Variations in atherosclerosis and remodeling patterns in aorta and carotids.

BACKGROUND: Atherosclerosis is a progressive disease that causes vascular remodeling that can be positive or negative. The evolution of arterial wall thickening and changes in lumen size under current "standard of care" in different arterial beds is unclear. The purpose of this study was to examine arterial remodeling and progression/regression of atherosclerosis in aorta and carotid arteries of individuals at risk for atherosclerosis normalized over a 1-year period. METHODS: In this study, 28 patients underwent at least 2 black-blood in vivo cardiovascular magnetic resonance (CMR) scans of aorta and carotids over a one-year period (Mean 17.8 +/- 7.5 months). Clinical risk profiles for atherosclerosis and medications were documented and patients were followed by their referring physicians under current "standard of care" guidelines. Carotid and aortic wall lumen areas were matched across the time-points from cross-sectional images. RESULTS: The wall area increased by 8.67%, 10.64%, and 13.24% per year (carotid artery, thoracic aorta and abdominal aorta respectively, p < 0.001). The lumen area of the abdominal aorta increased by 4.97% per year (p = 0.002), but the carotid artery and thoracic aorta lumen areas did not change significantly. The use of statin therapy did not change the rate of increase of wall area of carotid artery, thoracic and abdominal aorta, but decreased the rate of change of lumen area of carotid artery (-3.08 +/- 11.34 vs. 0.19 +/- 12.91 p < 0.05). CONCLUSIONS: Results of this study of multiple vascular beds indicated that different vascular locations exhibited varying progression of atherosclerosis and remodeling as monitored by CMR.

Comparison of 3D-diffusion-prepared segmented steady-state free precession and 2D fast spin echo imaging of femoral artery atherosclerosis.

Magnetic resonance (MR) imaging is a promising modality for the in vivo detection and characterization of atherosclerotic lesions in peripheral arteries. 2D imaging techniques for evaluation of peripheral artery disease (PAD) suffer from poor spatial coverage and have long scan times. The purpose of this study was to compare a diffusion prepared dark blood 3D steady state free precession (3D-DP-SSFP) sequence for evaluating atherosclerotic plaque burden in inguinal and thigh segments of the femoral artery and comparing the results obtained with 2D turbo spin echo (2D-TSE) techniques. A further goal of the study was to examine the inter observer reproducibility of MR plaque burden measures using the 3D DP-SSFP technique. Results of the study indicated higher signal to noise ratios for the 3D-DP-SSFP technique and higher CNR (better vessel-wall delineation) compared to the 2D-TSE technique. Furthermore, a good correlation between 3D-DP-SSFP and 2D-TSE techniques for the inguinal segment but poorer correlation for the thigh segment was observed. Inter-observer reproducibility for the 3D plaque burden measures was excellent. 3D-DP-SSFP may be a useful and reproducible technique for evaluating atherosclerosis in peripheral arteries.

Scapho-capitate Syndrome Variant: 180-Degree Rotation of the Proximal Capitate Fragment Without Identifiable Scaphoid Fracture.

Scapho-capitate fractures, also known as Fenton's Syndrome, occur very rarely. We report a case of a variant capitate fracture with a 180 degree rotation of the proximal fragment and no identifiable scaphoid fracture. Prompt identification of this fracture is necessary to minimize complications such as avascular necrosis.