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MRI pattern in asymptomatic natalizumab-associated PML.

Mike P Wattjes1, Anke Vennegoor2, Martijn D Steenwijk1

  • 1Department of Radiology and Nuclear Medicine, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.

Journal of Neurology, Neurosurgery, and Psychiatry
|September 11, 2014
PubMed
Summary

Early MRI signs of progressive multifocal leukoencephalopathy (PML) in multiple sclerosis patients treated with natalizumab often appear localized. These asymptomatic PML lesions frequently affect the frontal lobe

Keywords:
INFECTIOUS DISEASESMRIMULTIPLE SCLEROSISNEURORADIOLOGY

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Area of Science:

  • Neurology
  • Radiology
  • Immunology

Background:

  • Natalizumab is a treatment for multiple sclerosis (MS).
  • Progressive multifocal leukoencephalopathy (PML) is a rare but serious side effect of natalizumab treatment.
  • Detecting PML in its early, asymptomatic stage is crucial for patient outcomes.

Purpose of the Study:

  • To define the MRI characteristics of asymptomatic natalizumab-associated PML in MS patients.
  • To identify patterns that aid in early diagnosis.

Main Methods:

  • Retrospective and prospective analysis of MRI scans from 18 MS patients with natalizumab-associated PML.
  • Evaluation of lesion distribution, grey/white matter involvement, and signs of inflammation.
  • Creation of lesion probability maps to visualize distribution patterns.

Main Results:

  • Frontal lobe involvement was observed in 77.8% of patients.
  • Lesions were often focal and unilateral, frequently affecting cortical grey matter (83.3%).
  • A classical pattern of unilateral, unilobar frontal lesions involving cortical grey matter was seen in 44.4%.

Conclusions:

  • Asymptomatic natalizumab-associated PML on MRI typically presents as localized lesions, predominantly in the frontal lobes.
  • These lesions often affect the cortical grey matter and adjacent white matter.
  • Recognizing this pattern can lead to earlier diagnosis and potentially better prognoses.