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Research paper
MRI pattern in asymptomatic natalizumab-associated PML
  1. Mike P Wattjes1,
  2. Anke Vennegoor2,
  3. Martijn D Steenwijk1,
  4. Marlieke de Vos1,
  5. Joep Killestein2,
  6. Bob W van Oosten2,
  7. Jop Mostert3,
  8. Dorine A Siepman4,
  9. Wiebe Moll5,
  10. Alex E L van Golde6,
  11. Stephan T F M Frequin7,
  12. Nancy D Richert8,
  13. Frederik Barkhof1
  1. 1Department of Radiology and Nuclear Medicine, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
  2. 2Department of Neurology, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
  3. 3Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
  4. 4Department of Neurology, Erasmus MC, University Medical Center Rotterdam, MS Center, Rotterdam, The Netherlands
  5. 5Department of Neurology, Maasstad Hospital, Rotterdam, The Netherlands
  6. 6Department of Neurology, GT Hospital Almelo, Almelo, The Netherlands
  7. 7Department of Neurology, St. Antonius Hospital, Nieuwegein, The Netherlands
  8. 8Multiple Sclerosis Clinical Development Group, Biogen Idec, Cambridge, Massachusetts, USA
  1. Correspondence to Dr Mike P Wattjes, Department of Radiology & Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; m.wattjes{at}vumc.nl

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.

  • INFECTIOUS DISEASES
  • MRI
  • MULTIPLE SCLEROSIS
  • NEURORADIOLOGY

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