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Clinical characteristics and brain MRI findings in myeloproliferative neoplasms
Koichiro Nagai1, Takashi Shimoyama1, Hiroki Yamaguchi2
1Department of Neurology, Nippon Medical School, Tokyo, Japan.
Background:
Myeloproliferative neoplasms (MPNs) including polycythemia vera (PV) and essential thrombocythemia (ET) have an increased risk of ischemic stroke. However, little is known about brain morphological changes and the cerebral vasculature in MPNs. The aim of the present study is to clarify the prevalence rates of brain infarcts (BIs) on magnetic resonance imaging (MRI) and to assess the detailed clinical and MRI characteristics in those patients.
Methods:
We prospectively enrolled patients with MPNs who underwent brain MRI between September 2017 and June 2019. BI patterns were characterized by the numbers and locations of BIs on MRI.
Results:
A total of 101 patients were included in the present study. BIs were observed in 23 patients (23%). Multiple logistic regression analysis showed that age > 60 years (odds ratio (OR) 7.34, 95% confidence interval (CI) 1.08-49.7, p = .041) and history of thrombosis (OR 40.6, 95% CI 7.97-207, p < .0001) were independently associated with BIs, but not the JAK2V617F mutation. Of the 23 patients with BIs, eight patients (35%) had multiple territorial infarcts, and large vessel involvement was identified in five patients (22%). Two patients had thrombus formation in large vessels.
Conclusions:
Among patients with MPNs who underwent MRI, BIs were observed in 23% of patients followed up in our center. Older age and thrombosis history were independently associated with BIs. Some patients with MPNs may present with distinctive MRI findings including multiple territorial infarcts and thrombus formation in large vessels.
Insights
Brain infarcts (BIs) affect 23% of myeloproliferative neoplasm (MPN) patients. Older age and a history of thrombosis are key risk factors for BIs in MPN patients, not the JAK2V617F mutation.
Area of Science:
- Neurology
- Hematology
- Radiology
Background:
- Myeloproliferative neoplasms (MPNs), including polycythemia vera (PV) and essential thrombocythemia (ET), are associated with an elevated risk of ischemic stroke.
- Limited understanding exists regarding brain morphological changes and cerebral vasculature in MPN patients.
Purpose of the Study:
- To determine the prevalence of brain infarcts (BIs) using magnetic resonance imaging (MRI) in MPN patients.
- To analyze the clinical and MRI characteristics associated with BIs in this cohort.
Main Methods:
- Prospective enrollment of MPN patients undergoing brain MRI between September 2017 and June 2019.
- Characterization of BI patterns based on number and location on MRI scans.
Main Results:
- Out of 101 MPN patients, 23% (23 patients) showed evidence of BIs.
- Independent predictors for BIs included age > 60 years (OR 7.34) and a history of thrombosis (OR 40.6). The JAK2V617F mutation was not associated with BIs.
- Among patients with BIs, 35% had multiple territorial infarcts, and 22% showed large vessel involvement, with two cases of large vessel thrombus formation.
Conclusions:
- Brain infarcts (BIs) are present in 23% of MPN patients evaluated with MRI.
- Advanced age and a prior history of thrombosis are significant independent risk factors for BIs in MPN.
- Distinctive MRI findings, such as multiple territorial infarcts and large vessel thrombus, can be observed in some MPN patients.
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