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- Title
Progressive multifocal leukoencephalopathy: MRI findings in HIV-infected patients are closer to rituximab- than natalizumab-associated PML.
- Authors
Alleg, Manel; Solis, Morgane; Baloglu, Seyyid; Cotton, François; Kerschen, Philippe; Bourre, Bertrand; Ahle, Guido; Pruvo, Jean-Pierre; Leclerc, Xavier; Vermersch, Patrick; Papeix, Caroline; Maillart, Élisabeth; Houillier, Caroline; Chabrot, Cécile Moluçon; Claise, Béatrice; Malak, Sandra; Martin-Blondel, Guillaume; Bonneville, Fabrice; Caulier, Alexis; Marolleau, Jean-Pierre
- Abstract
<bold>Objectives: </bold>To compare brain MRI findings in progressive multifocal leukoencephalopathy (PML) associated to rituximab and natalizumab treatments and HIV infection.<bold>Materials and Methods: </bold>In this retrospective, multicentric study, we analyzed brain MRI exams from 72 patients diagnosed with definite PML: 32 after natalizumab treatment, 20 after rituximab treatment, and 20 HIV patients. We compared T2- or FLAIR-weighted images, diffusion-weighted images, T2*-weighted images, and contrast enhancement features, as well as lesion distribution, especially gray matter involvement.<bold>Results: </bold>The three PML entities affect U-fibers associated with low signal intensities on T2*-weighted sequences. Natalizumab-associated PML showed a punctuate microcystic appearance in or in the vicinity of the main PML lesions, a potential involvement of the cortex, and contrast enhancement. HIV and rituximab-associated PML showed only mild contrast enhancement, punctuate appearance, and cortical involvement. The CD4/CD8 ratio showed a trend to be higher in the natalizumab group, possibly mirroring a more efficient immune response.<bold>Conclusion: </bold>Imaging features of rituximab-associated PML are different from those of natalizumab-associated PML and are closer to those observed in HIV-associated PML.<bold>Key Points: </bold>• Nowadays, PML is emerging as a complication of new effective therapies based on monoclonal antibodies. • Natalizumab-associated PML shows more inflammatory signs, a perivascular distribution "the milky way," and more cortex involvement than rituximab- and HIV-associated PML. • MRI differences are probably related to higher levels of immunosuppression in HIV patients and those under rituximab therapy.
- Subjects
PROGRESSIVE multifocal leukoencephalopathy; JOHN Cunningham virus; NATALIZUMAB; MONOCLONAL antibodies; LEUKOENCEPHALOPATHIES; MAGNETIC resonance imaging; DIFFUSION magnetic resonance imaging; HIV infection complications; HIV infections; BRAIN; RETROSPECTIVE studies
- Publication
European Radiology, 2021, Vol 31, Issue 5, p2944
- ISSN
0938-7994
- Publication type
journal article
- DOI
10.1007/s00330-020-07362-y