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FLAIR and magnetization transfer imaging of patients with post-treatment Lyme disease syndrome
K Morgen1, R Martin, R D Stone
1Neuroimmunology Branch, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD 20892-1400, USA.
Objective:
To determine patterns of abnormalities on cerebral MRI that may characterize subgroups of patients with post-treatment Lyme disease syndrome (PTLDS) and to help identify pathomechanisms of disease.
Methods:
The authors analyzed the distribution of cerebral lesions in a cohort of 27 patients with PTLDS. A subgroup of eight patients with PTLDS was further studied using whole-brain magnetization transfer ratio measures to identify abnormalities not seen on T2-weighted images.
Results:
Four patients had focal neurologic deficits, relapsing-remitting disease, and lesions in a distribution typical of MS. Twenty-three patients presented with nonfocal symptoms such as fatigue, subjective memory deficits, and mood disturbance. Twelve of these patients had normal MRI, including the more sensitive fluid-attenuated inversion recovery sequence, 10 had primarily punctate and subcortical lesions, and one patient had multiple periventricular lesions.
Conclusions:
In a portion of patients with post-treatment Lyme disease syndrome, white-matter hyperintensities tend to occur in subcortical arteriolar watershed areas and are not specific. Magnetization transfer ratio analysis did not provide evidence for structural abnormalities of the brain parenchyma in patients with nonfocal disease.
Insights
Cerebral MRI in post-treatment Lyme disease syndrome (PTLDS) reveals white-matter hyperintensities in some patients, often in subcortical areas. Advanced imaging did not detect structural brain abnormalities in those with nonfocal PTLDS symptoms.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Post-treatment Lyme disease syndrome (PTLDS) presents with diverse symptoms, including fatigue and cognitive deficits.
- Cerebral magnetic resonance imaging (MRI) is used to investigate potential neurological underpinnings of PTLDS.
- Understanding MRI findings may help differentiate PTLDS subgroups and elucidate disease mechanisms.
Purpose of the Study:
- To identify characteristic cerebral MRI abnormality patterns in PTLDS patients.
- To explore potential pathomechanisms of PTLDS through neuroimaging.
- To characterize subgroups within the PTLDS population based on MRI findings.
Main Methods:
- Cerebral MRI lesion distribution was analyzed in 27 PTLDS patients.
- A subgroup of 8 PTLDS patients underwent whole-brain magnetization transfer ratio (MTR) measures.
- MTR analysis aimed to detect abnormalities not visible on standard T2-weighted MRI.
Main Results:
- Four PTLDS patients exhibited focal neurological deficits and MS-typical lesions.
- Twenty-three patients presented with nonfocal symptoms; 12 had normal MRI, 10 showed punctate/subcortical lesions, and 1 had periventricular lesions.
- MTR analysis revealed no evidence of structural brain parenchyma abnormalities in nonfocal PTLDS patients.
Conclusions:
- White-matter hyperintensities in some PTLDS patients occur in subcortical arteriolar watershed areas and are non-specific.
- MRI findings in PTLDS can vary, with some patients showing MS-like lesions and others exhibiting subtle or no abnormalities.
- Magnetization transfer ratio imaging did not identify parenchymal abnormalities in PTLDS patients with nonfocal symptoms.
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