MRI pattern in asymptomatic natalizumab-associated PML. Issue 7 (9th September 2014)

• Record Type: Journal Article
• Authors: Wattjes, Mike P; Vennegoor, Anke; Steenwijk, Martijn D; de Vos, Marlieke; Killestein, Joep; van Oosten, Bob W; Mostert, Jop; Siepman, Dorine A; Moll, Wiebe; van Golde, Alex E L; Frequin, Stephan T F M; Richert, Nancy D; Barkhof, Frederik
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 86:Issue 7(2015)
• Page Start: 793
• Page End: 798
• Publication Date: 2014-09-09
• Subjects: INFECTIOUS DISEASES -- MRI -- MULTIPLE SCLEROSIS -- NEURORADIOLOGY; Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp-2014-308630
• Languages: English
• ISSNs: 0022-3050

Abstract

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.