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[MRI alterations in immunomodulation].

K Guggenberger, H Urbach1

  • 1Klinik für Neuroradiologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland. horst.urbach@uniklinik-freiburg.de.

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Summary
This summary is machine-generated.

This review highlights key MRI findings for diseases linked to immunomodulatory drugs, including progressive multifocal leukoencephalopathy (PML) and immune reconstitution inflammatory syndrome (IRIS). Understanding these patterns is crucial for patients undergoing immunosuppressive therapies.

Keywords:
HypophysitisInflammatory immune reconstitution syndromeOrgan transplantationProgressive multifocal leucencephalopathyStem cell transplantation

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Area of Science:

  • Neurology
  • Radiology
  • Immunology

Background:

  • Immunomodulatory drugs are increasingly used for various conditions, including multiple sclerosis and lymphoproliferative diseases.
  • These therapies can lead to opportunistic infections and inflammatory syndromes affecting the brain.
  • Accurate diagnosis relies on recognizing specific imaging patterns.

Purpose of the Study:

  • To present typical magnetic resonance imaging (MRI) findings associated with diseases induced by immunomodulatory drugs.
  • To emphasize the importance of recognizing these patterns in the context of immunosuppressive treatments.
  • To raise awareness of potential T-lymphocyte-mediated neurotoxicity.

Main Methods:

  • Review of scientific literature focusing on neuroimaging in patients treated with immunomodulatory agents.
  • Compilation of characteristic MRI patterns for conditions such as PML, IRIS, methotrexate-associated leukoencephalopathy, and PRES.
  • Discussion of the pathomechanisms underlying these imaging findings.

Main Results:

  • Progressive multifocal leukoencephalopathy (PML) exhibits a distinct MRI pattern, particularly relevant in multiple sclerosis (MS) patients on natalizumab, fingolimod, rituximab, or fumarate.
  • Immune reconstitution inflammatory syndrome (IRIS) can present with overlapping and severe inflammatory changes upon immune system restoration.
  • Methotrexate-associated leukoencephalopathy and posterior reversible encephalopathy syndrome (PRES) are other key conditions with identifiable MRI signatures.

Conclusions:

  • Recognizing specific MRI patterns is essential for diagnosing drug-induced neurological complications during immunomodulatory therapy.
  • Awareness of PML, IRIS, and other entities aids in timely management and can prevent misdiagnosis.
  • Immunotherapy targeting T-lymphocytes carries a risk of off-target effects on healthy brain tissue.