Clinical Utility of Computed Tomography and Magnetic Resonance Imaging for Diagnosis of Posterior Reversible Encephalopathy Syndrome after Stem Cell.

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Clinical Utility of Computed Tomography and Magnetic Resonance Imaging for Diagnosis of Posterior Reversible Encephalopathy Syndrome after Stem Cell Transplantation in Children and Adolescents Christopher E. Dandoy, Luke L. Linscott, Stella M. Davies, James L. Leach, Kasiani C. Myers, Javier El-Bietar, Ranjit S. Chima, Abigail Pate, Adam Nelson, Gregory Wallace, Hector R. Wong, Sonata Jodele Biology of Blood and Marrow Transplantation Volume 21, Issue 11, Pages 2028-2032 (November 2015) DOI: 10.1016/j.bbmt.2015.07.023 Copyright © 2015 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 1 Diagnostic imaging category of the 54 patients who underwent neuroimaging for new neurologic symptoms. All patients underwent neuroimaging at time of presentation to the pediatric intensive care unit. Category 1 PRES was diagnosed in 21 patients. One patient was diagnosed with MRI alone; 4 were diagnosed with CT alone; 4 were diagnosed with CT and MRI; and 12 patients had normal CT, but positive MRI. In category 2, 13 patients had an alternative diagnosis other than PRES; all 13 underwent CT and MRI. In category 3, 5 patients had nonspecific findings on neuroimaging; all 5 underwent CT and MRI. In category 4, 15 patients had no acute neuroimaging findings; CT was performed in all 15 patients, 5 received both CT and MRI. Biology of Blood and Marrow Transplantation 2015 21, 2028-2032DOI: (10.1016/j.bbmt.2015.07.023) Copyright © 2015 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 2 Four-year-old female with severe combined immune deficiency who developed seizures 5 days after HSCT. Axial CT images show large areas of decreased attenuation and loss of the gray-white junction in a nonvascular, watershed distribution, most consistent with PRES. No MRI was performed. Biology of Blood and Marrow Transplantation 2015 21, 2028-2032DOI: (10.1016/j.bbmt.2015.07.023) Copyright © 2015 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 3 Seven-year-old male who developed seizures 68 days after HSCT. (A) Head CT examination was normal. (B) Axial fluid-attenuated inversion recovery images from a brain MRI examination performed 4 hours later demonstrates multiple cortical and subcortical foci of signal abnormality consistent with PRES. Biology of Blood and Marrow Transplantation 2015 21, 2028-2032DOI: (10.1016/j.bbmt.2015.07.023) Copyright © 2015 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 4 Diagnostic algorithm for patients with new neurologic symptoms after stem cell transplantation. Biology of Blood and Marrow Transplantation 2015 21, 2028-2032DOI: (10.1016/j.bbmt.2015.07.023) Copyright © 2015 American Society for Blood and Marrow Transplantation Terms and Conditions