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J Neurol Neurosurg Psychiatry. 2015 Jul;86(7):793-8. doi: 10.1136/jnnp-2014-308630. Epub 2014 Sep 9.

MRI pattern in asymptomatic natalizumab-associated PML.

Author information

1
Department of Radiology and Nuclear Medicine, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
2
Department of Neurology, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
3
Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands.
4
Department of Neurology, Erasmus MC, University Medical Center Rotterdam, MS Center, Rotterdam, The Netherlands.
5
Department of Neurology, Maasstad Hospital, Rotterdam, The Netherlands.
6
Department of Neurology, GT Hospital Almelo, Almelo, The Netherlands.
7
Department of Neurology, St. Antonius Hospital, Nieuwegein, The Netherlands.
8
Multiple Sclerosis Clinical Development Group, Biogen Idec, Cambridge, Massachusetts, USA.

Abstract

OBJECTIVE:

To investigate the MRI manifestation pattern of asymptomatic natalizumab-associated progressive multifocal leukoencephalopathy (PML) in patients with multiple sclerosis (MS).

METHODS:

18 patients with MS with natalizumab-associated PML lesions on MRI were included. In 6 patients, the PML lesions were identified on MRI prospectively and in 12 patients PML lesions were identified retrospectively. MRI sequences were analysed for PML lesion distribution, appearance, grey matter/white matter involvement and possible signs of inflammation. Lesion probability maps were created to demonstrate lesion distribution pattern.

RESULTS:

The frontal lobe was involved in 14 patients (77.8%) and the parietal lobe in 4 patients (22.2%). Most patients presented with focal lesions (13 patients, 72.2%) involving one single lobe (12 patients, 66.7%). The cortical grey matter was affected in 15 patients (83.3%) and 13 patients (72.2%) presented with a combination of cortical grey and white matter involvement. Signs of inflammation were detected in 7 patients (38.8%). Among patients with available diffusion-weighted imaging, 6 patients (40%) did not show high-signal-intensity lesions. A classical imaging pattern including unilateral and unilobar focal lesions in the frontal lobe affecting the cortical grey matter or the cortical grey and adjacent white matter was observed in 8 patients (44.4%).

CONCLUSIONS:

Asymptomatic natalizumab-associated PML manifestations on MRI show a rather localised disease, frequently located in the frontal lobes, affecting the cortical grey matter and adjacent juxtacortical white matter. Awareness of this lesion pattern facilitates an earlier diagnosis of natalizumab-associated PML in an asymptomatic stage associated with a more favourable prognosis.

KEYWORDS:

INFECTIOUS DISEASES; MRI; MULTIPLE SCLEROSIS; NEURORADIOLOGY

PMID:
25205744
DOI:
10.1136/jnnp-2014-308630
[Indexed for MEDLINE]

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