MRI characteristics of early PML-IRIS after natalizumab treatment in patients with MS. Issue 8 (14th September 2015)

• Record Type: Journal Article
• Authors: Wattjes, Mike P; Wijburg, Martijn T; Vennegoor, Anke; Witte, Birgit I; de Vos, Marlieke; Richert, Nancy D; Uitdehaag, Bernard M J; Barkhof, Frederik; Killestein, Joep
• Other Names: author non-byline.; van Oosten Bob W author non-byline.; Polman Chris H author non-byline.; Siepman Dorine A author non-byline.; Hintzen Rogier author non-byline.; Mostert Jop author non-byline.; Moll Wibe author non-byline.; van Golde Alex EL author non-byline.; Frequin Stephan TFM author non-byline.; Bouma Paul AD author non-byline.; Quivron Bénédicte author non-byline.; Braeckeveldt Jean author non-byline.; Munster Erik van author non-byline.; Eijk Jeroen van author non-byline.; Heersema Thea author non-byline.; Graaf Jaap de author non-byline.
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 87:Issue 8(2016)
• Page Start: 879
• Page End: 884
• Publication Date: 2015-09-14
• Subjects: Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp-2015-311411
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : Objective: The early detection of MRI findings suggestive of immune reconstitution inflammatory syndrome (IRIS) in natalizumab-associated progressive multifocal leukoencephalopathy (PML) is of crucial clinical relevance in terms of treatment decision-making and clinical outcome. The aim of this study was to investigate the earliest imaging characteristics of PML-IRIS manifestation in natalizumab-treated patients with multiple sclerosis and describe an imaging pattern that might aid in the early and specific diagnosis. Methods: This was a retrospective study assessing brain MRI of 26 patients with natalizumab-associated PML presenting with lesions suggestive of PML-IRIS during follow-up. MRI findings were evaluated considering the imaging findings such as mass effect, swelling, contrast enhancement, new perivascular T2 lesions and signs suggestive of meningeal inflammation. Results: Contrast enhancement was the most common imaging sign suggestive of PML-IRIS, seen in 92.3% of the patients (with patchy and/or punctuate pattern in 70.8% and 45.8% respectively), followed by new T2 lesions with a perivascular distribution pattern (34.6%). In those patients with contrast enhancement, the enhancement was present in the lesion periphery in 95.8% of the patients. Contrast-enhancing lesions with a perivascular distribution pattern outside of the PML lesion were observed in 33.3% of the patients. The most common overall pattern was contrast enhancement in the border of the PML lesion with either a patchy or punctuate appearance in 88.5% of all patients. Conclusions: Contrast enhancement is the most common earliest sign of natalizumab-associated PML-IRIS with a frequent imaging pattern of contrast-enhancing lesions with either a patchy or punctuate appearance in the border of the PML lesion.