Added Value of Arterial Spin Labeling in Detecting Posterior Reversible Encephalopathy Syndrome as a Stroke Mimic on Baseline Neuroimaging: A Single Center Experience

Joseph D Weinstein; Omar Hamam; Victor C Urrutia; Hanzhang Lu; Licia P Luna; Aylin Tekes-Brady; Mona Bahouth; Vivek Yedavalli

doi:10.3389/fneur.2022.831218

Added Value of Arterial Spin Labeling in Detecting Posterior Reversible Encephalopathy Syndrome as a Stroke Mimic on Baseline Neuroimaging: A Single Center Experience

Front Neurol. 2022 Mar 3:13:831218. doi: 10.3389/fneur.2022.831218. eCollection 2022.

Authors

Joseph D Weinstein¹, Omar Hamam¹, Victor C Urrutia², Hanzhang Lu³, Licia P Luna¹, Aylin Tekes-Brady⁴, Mona Bahouth⁵, Vivek Yedavalli⁶

Affiliations

¹ Department of Radiology and Radiological Sciences, Division of Neuroradiology, Johns Hopkins School of Medicine, Baltimore, MD, United States.
² Department of Neurology, Comprehensive Stroke Center, Johns Hopkins School of Medicine, Baltimore, MD, United States.
³ Neurofunction MRI Section, MR Research Division, Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States.
⁴ Division of Pediatric Radiology and Pediatric Neuroradiology, Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States.
⁵ Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States.
⁶ Division of Neuroradiology, Stroke Imaging, Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States.

Abstract

Differentiating stroke from stroke mimics is a diagnostic challenge in every day practice. Posterior Reversible Encephalopathy Syndrome (PRES) is an important stroke mimic with nonspecific symptomatology, making prompt and accurate diagnosis challenging. Baseline neuroimaging plays a pivotal role in detection and differentiation of stroke from many common mimics and is thus critical in guiding appropriate management. In particular, MR perfusion (MRP) imaging modalities provide added value through detection and quantification of multiple physiological parameters. Arterial Spin Labeling (ASL) is a non-contrast, noninvasive MRP technique increasingly used in clinical practice; however, there is limited description of ASL in PRES in the existing literature. In this single center retrospective pilot study, we investigate the added value of ASL in detecting PRES in the largest series to date. We hope this study can serve as the basis for larger scale investigations exploring the utility of ASL in detecting stroke mimics such as PRES for accurate and efficient management of such patients.

Keywords: MR perfusion; PRES; arterial spin labeling; perfusion imaging; stroke imaging; stroke mimic.