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Early diagnosis of progressive multifocal leucoencephalopathy: longitudinal lesion evolution
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  • Published on: 24 November 2018
    EARLY DIAGNOSIS OF PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY: A STILL UNRESOLVED CLINICAL CHALLENGE
    • Giuseppe Pontillo, Neuroradiologist Department of Advanced Biomedical Sciences, University of Naples "Federico II"
    • Other Contributors:
      • Sirio Cocozza, Neuroradiologist
      • Enrico Tedeschi, Neuroradiologist

    Dear Editor,
    We have read with great interest the work by Scarpazza et al that provided a longitudinal MRI evaluation of natalizumab-related Progressive Multifocal Leukoencephalopathy (NTZ-PML) lesions in Multiple Sclerosis (MS) patients (1).
    Their central finding was the high percentage (78.1%) of patients, who eventually developed NTZ-PML, in whom highly suggestive lesions were already retrospectively detectable on pre-diagnostic MRI exams. Furthermore, the pre-diagnostic phase proved to be relatively long (150.8±74.9 days), with an estimated percentage increase of the lesions’ volume of 62.8% per month (1).
    Given the widely recognized crucial role of a timely NTZ-PML identification in reducing mortality and residual disability (1), these results present the neurological and neuroradiological communities with an important clinical challenge, prompting a major effort to ensure an early diagnosis of this condition.
    Although redefining the timing of MRI surveillance, with up to one brain MRI exam every 3-4 months for high-risk patients, appears as a justified strategy, we think that improving the accuracy of early identification of NTZ-PML is also mandatory.
    In our opinion, such achievement should be pursued using two complementary approaches: (i) a specific training addressed to neuroradiologists working in the field of MS, who should be aware of the relevance of even very small asymptomatic PML lesions and how to differentiate them from new M...

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    Conflict of Interest:
    None declared.