E2338. A Primer for the Radiology Resident: Imaging of Reversible Cerebral Vascular Pathology
Authors
Kenneth Danielson;
University of Cincinnati
David Wang;
I-MED Radiology Network
Background
Reversible cerebral vascular diseases including reversible cerebral vasoconstriction syndrome (RCVS), posterior reversible encephalopathy syndrome (PRES), and primary angiitis of the central nervous syndrome (PACNS) have many overlapping clinical and radiologic features which may confound the diagnosis. These entities can be characterized on different imaging modalities, each with its own advantages and disadvantages. Knowledge of each of the above diseases and their distinguishing features will aid the diagnosis and management of patients.
Educational Goals / Teaching Points
Review the pathophysiology of reversible cerebral vascular diseases: RCVS, PRES, and PACNS. Review the role and utilization of various imaging modalities in the diagnosis and management of RCVS, PRES, and PACNS. Describe pertinent imaging findings of RCVS, PRES, and PACNS. Summarize the similarities and differences of the above diseases on imaging.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Vessel narrowing, vessel wall thickening, subarachnoid hemorrhage, lobar hemorrhage, ischemic infarction, and hypoperfusion are hallmarks of reversible cerebral vascular diseases. Imaging modalities such as CT, CTA, MRI, MRV, diagnostic cerebral angiogram, and perfusion studies are often used to image these diseases. Examples will be provided to illustrate their characteristic imaging features of the diseases. In addition, different patterns of PRES will also be discussed.
Conclusion
Distinguishing RCVS, PRES and PACNS clinically and radiographically can be challenging. Collaboration with the neurologists and the radiologists’ knowledge of multimodality imaging features are crucial in the prompt, accurate diagnosis and management of these conditions.
