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Diffusion imaging may predict reversible brain lesions in eclampsia and severe preeclampsia: initial experience.
Ricardo Loureiro1, Claudia C Leite, Soubhi Kahhale
1Department of Radiology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil. rlradiol@bol.com.br
American Journal of Obstetrics and Gynecology
|November 25, 2003
Summary
Diffusion-weighted MRI accurately predicts brain edema outcomes in severe preeclampsia patients. This imaging technique helps differentiate reversible vasogenic edema from irreversible cytotoxic edema and infarction.
Area of Science:
- Neurology
- Radiology
- Obstetrics
Background:
- Eclampsia and severe preeclampsia can cause brain edema.
- The pathophysiologic basis and prognostic indicators of this edema require further elucidation.
Purpose of the Study:
- To validate diffusion-weighted magnetic resonance imaging (DW-MRI) for predicting brain edema evolution in eclampsia/severe preeclampsia.
- To establish the pathophysiologic presence of brain edema in these patients.
Main Methods:
- Seventeen patients with severe eclampsia/preeclampsia and brain lesions underwent MRI at admission and 8 weeks later.
- Diffusion-weighted imaging was used to assess water mobility in edematous brain regions.
Main Results:
- Brain edema was reversible in 13 patients and irreversible in 4.
- DW-MRI accurately predicted reversibility in 16 of 17 patients at admission.
- Increased water mobility in the reversible group and restricted diffusion (cytotoxic edema/infarction) in the irreversible group were observed.
Conclusions:
- DW-MRI is a successful predictor of brain edema's evolutive course in acute eclampsia/severe preeclampsia.
- Brain edema is predominantly vasogenic, but ischemic/cytotoxic edema and infarction can occur.