RT Journal Article
SR Electronic
T1 MRI criteria differentiating asymptomatic PML from new MS lesions during natalizumab pharmacovigilance
JF Journal of Neurology, Neurosurgery & Psychiatry
JO J Neurol Neurosurg Psychiatry
FD BMJ Publishing Group Ltd
SP 1138
OP 1145
DO 10.1136/jnnp-2016-313772
VO 87
IS 10
A1 Martijn T Wijburg
A1 Birgit I Witte
A1 Anke Vennegoor
A1 Stefan D Roosendaal
A1 Esther Sanchez
A1 Yaou Liu
A1 Carine O Martins Jarnalo
A1 Bernard MJ Uitdehaag
A1 Frederik Barkhof
A1 Joep Killestein
A1 Mike P Wattjes
YR 2016
UL http://jnnp.bmj.com/content/87/10/1138.abstract
AB Objective Differentiation between progressive multifocal leukoencephalopathy (PML) and new multiple sclerosis (MS) lesions on brain MRI during natalizumab pharmacovigilance in the absence of clinical signs and symptoms is challenging but is of substantial clinical relevance. We aim to define MRI characteristics that can aid in this differentiation.Methods Reference and follow-up brain MRIs of natalizumab-treated patients with MS with asymptomatic PML (n=21), or asymptomatic new MS lesions (n=20) were evaluated with respect to characteristics of newly detected lesions by four blinded raters. We tested the association with PML for each characteristic and constructed a multivariable prediction model which we analysed using a receiver operating characteristic (ROC) curve.Results Presence of punctate T2 lesions, cortical grey matter involvement, juxtacortical white matter involvement, ill-defined and mixed lesion borders towards both grey and white matter, lesion size of >3 cm, and contrast enhancement were all associated with PML. Focal lesion appearance and periventricular localisation were associated with new MS lesions. In the multivariable model, punctate T2 lesions and cortical grey matter involvement predict for PML, while focal lesion appearance and periventricular localisation predict for new MS lesions (area under the curve: 0.988, 95% CI 0.977 to 1.0, sensitivity: 100%, specificity: 80.6%).Interpretation The MRI characteristics of asymptomatic natalizumab-associated PML lesions proved to differ from new MS lesions. This led to a prediction model with a high discriminating power. Careful assessment of the presence of punctate T2 lesions, cortical grey matter involvement, focal lesion appearance and periventricular localisation allows for an early diagnosis of PML.