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Updated: Mar 30, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
7T MRI in natalizumab-associated PML and ongoing MS disease activity: A case study
Tim Sinnecker1, Jalal Othman1, Marc Kühl1
1Department of Neurology (T.S., J.O., M.K., I.S., A.K., P.W., P.K., J.F.), Asklepios Fachklinikum Teupitz; NeuroCure Clinical Research Center (T.S., F.P., J.W.), Experimental and Clinical Research Center (T.N., F.P.), Department of Neurology (F.P.), and Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Charité-Universitätsmedizin Berlin; Medical Physics (R.M.), Physikalisch-Technische Bundesanstalt; Berlin Ultrahigh Field Facility (T.N., J.W.) and Experimental and Clinical Research Center (T.N., F.P.), Max Delbrück Center for Molecular Medicine, Berlin; Institute of Neuroradiology (J.W.), Universitätsmedizin Göttingen, Germany; and MIAC AG (J.W.), Basel, Switzerland.
Objective:
To assess the ability of ultra-high-field MRI to distinguish early progressive multifocal leukoencephalopathy (PML) from multiple sclerosis (MS) lesions in a rare case of simultaneous presentation of natalizumab-associated PML and ongoing MS activity.
Methods:
Advanced neuroimaging including 1.5T, 3T, and 7T MRI with a spatial resolution of up to 0.08 mm(3) was performed.
Results:
7T MRI differentiated between PML-related and MS-related brain damage in vivo. Ring-enhancing MS plaques displayed a central vein, whereas confluent PML lesions were preceded by punctate or milky way-like T2 lesions.
Conclusions:
Given the importance of early diagnosis of treatment-associated PML, future systematic studies are warranted to assess the value of highly resolving MRI in differentiating between early PML- and MS-induced brain parenchymal lesions.
Insights
Ultra-high-field 7T MRI can differentiate early progressive multifocal leukoencephalopathy (PML) from multiple sclerosis (MS) lesions. This advanced imaging technique shows distinct characteristics for each condition, aiding in diagnosis.
Area of Science:
- Neuroimaging
- Radiology
- Neurology
Background:
- Distinguishing progressive multifocal leukoencephalopathy (PML) from multiple sclerosis (MS) is crucial for patient management, especially in cases of simultaneous presentation.
- Natalizumab treatment can increase the risk of PML, necessitating accurate and timely diagnosis.
Purpose of the Study:
- To evaluate the capability of ultra-high-field magnetic resonance imaging (MRI) in differentiating early natalizumab-associated PML from active MS lesions.
- To investigate the unique imaging signatures of PML and MS lesions using advanced MRI techniques.
Main Methods:
- Utilized advanced neuroimaging across multiple field strengths (1.5T, 3T, and 7T MRI).
- Achieved high spatial resolution of up to 0.08 mm³ to visualize subtle brain lesions.
- Analyzed imaging data from a rare case presenting with both simultaneous PML and MS activity.
Main Results:
- 7T MRI successfully differentiated between PML-related and MS-related brain damage in vivo.
- Multiple sclerosis plaques showed ring enhancement with a central vein.
- Progressive multifocal leukoencephalopathy lesions appeared as confluent areas preceded by punctate or 'milky way-like' T2 lesions.
Conclusions:
- The findings suggest that highly resolving MRI, particularly 7T, holds significant promise for distinguishing early PML from MS lesions.
- Early and accurate diagnosis of treatment-associated PML is critical.
- Further systematic studies are recommended to validate the utility of high-resolution MRI in differentiating early PML and MS brain lesions.
