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[Progressive multifocal leukoencephalopathy. Role of imaging in its diagnosis. Perspectives]
Z Magalhães1, A M Reis, P Moniz
1Serviços de Neurorradiologia, Neurologia, Medicina, Hospital Pedro Hispano, Matosinhos.
Abstract:
We review five cases of Progressive Multifocal Leukoencephalopathy (PML), confirmed by biopsy in three cases and by LCR JC virus research by PCR (polymerase chain reaction) in two cases. We analysed the lesions and different forms of imagiological presentation, concerning location, mass effect, contrast enhancement and progress, and emphasize the importance of some atypical patterns. Reference is also made to the role of imaging in its diagnosis and new techniques, such as Spectroscopy and Transfer Magnetization, to avoid brain biopsy.
Insights
This review examines five cases of Progressive Multifocal Leukoencephalopathy (PML), highlighting imaging techniques for diagnosis. Advanced methods like Spectroscopy and Transfer Magnetization may help avoid invasive brain biopsies.
Area of Science:
- Neurology
- Radiology
- Infectious Diseases
Background:
- Progressive Multifocal Leukoencephalopathy (PML) is a rare, demyelinating disease affecting the brain.
- PML is caused by the JC virus (JCV) and often occurs in immunocompromised individuals.
- Accurate and timely diagnosis is crucial for patient management.
Purpose of the Study:
- To review imaging findings in five confirmed cases of PML.
- To analyze lesion characteristics, including location, mass effect, contrast enhancement, and progression.
- To emphasize the diagnostic utility of atypical imaging patterns and emerging techniques.
Main Methods:
- Case series review of five patients with confirmed PML.
- Analysis of radiological features from MRI scans.
- Confirmation of PML by brain biopsy in three cases and JCV PCR in cerebrospinal fluid (CSF) in two cases.
- Exploration of advanced imaging techniques like Spectroscopy and Magnetization Transfer.
Main Results:
- Detailed analysis of lesion morphology and distribution in the reviewed PML cases.
- Identification of various imagiological presentations, including common and atypical patterns.
- Demonstration of the role of imaging in characterizing PML lesions and their evolution.
- Evaluation of the potential of advanced imaging to aid in diagnosis.
Conclusions:
- Imaging plays a critical role in the diagnosis and management of PML.
- Atypical imaging findings can be indicative of PML and warrant further investigation.
- Emerging techniques like Spectroscopy and Magnetization Transfer show promise in improving diagnostic accuracy and potentially avoiding brain biopsy.