Magnetic resonance imaging changes following natalizumab discontinuation in multiple sclerosis patients with progressive multifocal leukoencephalopathy. (December 2018)

• Record Type: Journal Article
• Authors: Hodel, Jérôme; Bapst, Blanche; Outteryck, Olivier; Verclytte, Sébastien; Deramecourt, Vincent; Benadjaoud, Mohamed Amine; Pruvo, Jean-Pierre; Vermersch, Patrick; Leclerc, Xavier
• Is Part Of: Multiple sclerosis. Volume 24:Number 14(2018)
• Page Start: 1902
• Page End: 1908
• Publication Date: 2018-12
• Subjects: Multiple sclerosis -- natalizumab -- immune reconstitution inflammatory syndrome -- magnetic resonance imaging -- diffusion-weighted imaging; Central nervous system -- Diseases -- Periodicals; Myelin sheath -- Diseases -- Periodicals; Inflammation -- Periodicals; Multiple sclerosis -- Periodicals; Central Nervous System Diseases -- Periodicals; Demyelinating Diseases -- Periodicals; Inflammation -- Periodicals; Multiple Sclerosis -- Periodicals; Système nerveux central -- Maladies -- Périodiques; Gaine de myéline -- Maladies -- Périodiques; Inflammation (Pathologie) -- Périodiques; Sclérose en plaques -- Périodiques; Electronic journals; 616.834005
• DOI: 10.1177/1352458517750765
• Languages: English
• ISSNs: 1352-4585

Abstract

Background: Detecting early progressive multifocal leukoencephalopathy-immune reconstitution inflammatory syndrome (PML-IRIS) is clinically relevant. Objective: Evaluating magnetic resonance imaging (MRI) changes following natalizumab (NTZ) discontinuation and preceding PML-IRIS. Methods: MRIs (including diffusion-weighted imaging (DWI), T2-weighted fluid-attenuated inversion recovery (T2-FLAIR), post-contrast T1-weighted sequences) were performed every week following PML diagnosis in 11 consecutive NTZ-PML patients. PML expansion, punctate lesions, contrast-enhancement, and mass-effect/edema were evaluated on each MRI sequence, following NTZ discontinuation. Results: PML-IRIS occurred from 26 to 89 days after NTZ discontinuation. MRI changes prior to early PML-IRIS appeared significantly more pronounced using DWI compared to T2-FLAIR imaging ( p < 0.003). Two DWI features (marked PML expansion, punctate lesions) systematically preceded contrast-enhancement. Conclusion: Subtle changes may occur on DWI preceding contrast-enhancement.