Mike P Wattjes1, Martijn T Wijburg2, Anke Vennegoor3, Birgit I Witte4, Marlieke de Vos1, Nancy D Richert5, Bernard M J Uitdehaag3, Frederik Barkhof1, Joep Killestein3. 1. MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands. 2. MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands. 3. MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands. 4. Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands. 5. Multiple Sclerosis Clinical Development Group, Biogen, Cambridge, Massachusetts, USA.
Abstract
OBJECTIVE: The early detection of MRI findings suggestive of immune reconstitution inflammatory syndrome (IRIS) in natalizumab-associated progressive multifocal leukoencephalopathy (PML) is of crucial clinical relevance in terms of treatment decision-making and clinical outcome. The aim of this study was to investigate the earliest imaging characteristics of PML-IRIS manifestation in natalizumab-treated patients with multiple sclerosis and describe an imaging pattern that might aid in the early and specific diagnosis. METHODS: This was a retrospective study assessing brain MRI of 26 patients with natalizumab-associated PML presenting with lesions suggestive of PML-IRIS during follow-up. MRI findings were evaluated considering the imaging findings such as mass effect, swelling, contrast enhancement, new perivascular T2 lesions and signs suggestive of meningeal inflammation. RESULTS: Contrast enhancement was the most common imaging sign suggestive of PML-IRIS, seen in 92.3% of the patients (with patchy and/or punctuate pattern in 70.8% and 45.8% respectively), followed by new T2 lesions with a perivascular distribution pattern (34.6%). In those patients with contrast enhancement, the enhancement was present in the lesion periphery in 95.8% of the patients. Contrast-enhancing lesions with a perivascular distribution pattern outside of the PML lesion were observed in 33.3% of the patients. The most common overall pattern was contrast enhancement in the border of the PML lesion with either a patchy or punctuate appearance in 88.5% of all patients. CONCLUSIONS: Contrast enhancement is the most common earliest sign of natalizumab-associated PML-IRIS with a frequent imaging pattern of contrast-enhancing lesions with either a patchy or punctuate appearance in the border of the PML lesion. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
OBJECTIVE: The early detection of MRI findings suggestive of immune reconstitution inflammatory syndrome (IRIS) in natalizumab-associated progressive multifocal leukoencephalopathy (PML) is of crucial clinical relevance in terms of treatment decision-making and clinical outcome. The aim of this study was to investigate the earliest imaging characteristics of PML-IRIS manifestation in natalizumab-treated patients with multiple sclerosis and describe an imaging pattern that might aid in the early and specific diagnosis. METHODS: This was a retrospective study assessing brain MRI of 26 patients with natalizumab-associated PML presenting with lesions suggestive of PML-IRIS during follow-up. MRI findings were evaluated considering the imaging findings such as mass effect, swelling, contrast enhancement, new perivascular T2 lesions and signs suggestive of meningeal inflammation. RESULTS: Contrast enhancement was the most common imaging sign suggestive of PML-IRIS, seen in 92.3% of the patients (with patchy and/or punctuate pattern in 70.8% and 45.8% respectively), followed by new T2 lesions with a perivascular distribution pattern (34.6%). In those patients with contrast enhancement, the enhancement was present in the lesion periphery in 95.8% of the patients. Contrast-enhancing lesions with a perivascular distribution pattern outside of the PML lesion were observed in 33.3% of the patients. The most common overall pattern was contrast enhancement in the border of the PML lesion with either a patchy or punctuate appearance in 88.5% of all patients. CONCLUSIONS: Contrast enhancement is the most common earliest sign of natalizumab-associated PML-IRIS with a frequent imaging pattern of contrast-enhancing lesions with either a patchy or punctuate appearance in the border of the PML lesion. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Authors: Joseph C J Bot; Linda Mazzai; Rogier E Hagenbeek; Silvia Ingala; Bob van Oosten; Esther Sanchez-Aliaga; Frederik Barkhof Journal: Neuroradiology Date: 2020-01-10 Impact factor: 2.804
Authors: Robbert-Jan Gieselbach; Annemarie H Muller-Hansma; Martijn T Wijburg; Marjolein S de Bruin-Weller; Bob W van Oosten; Dennis J Nieuwkamp; Frank E Coenjaerts; Mike P Wattjes; Jean-Luc Murk Journal: J Neurol Date: 2017-05-23 Impact factor: 4.849
Authors: Martijn T Wijburg; Iris Kleerekooper; Birgit I Lissenberg-Witte; Marlieke de Vos; Clemens Warnke; Bernard M J Uitdehaag; Frederik Barkhof; Joep Killestein; Mike P Wattjes Journal: JAMA Neurol Date: 2018-07-01 Impact factor: 18.302