PMID- 22914832
OWN - NLM
STAT- MEDLINE
DCOM- 20130321
LR  - 20220316
IS  - 1526-632X (Electronic)
IS  - 0028-3878 (Print)
IS  - 0028-3878 (Linking)
VI  - 79
IP  - 10
DP  - 2012 Sep 4
TI  - Metabolic profile of PML lesions in patients with and without IRIS: an 
      observational study.
PG  - 1041-8
LID - 10.1212/WNL.0b013e318268465b [doi]
AB  - OBJECTIVE: To characterize progressive multifocal leukoencephalopathy (PML) 
      lesions by contrast-enhanced MRI and evaluate their metabolism using proton 
      magnetic resonance spectroscopy ((1)H- MRS) in the setting of immune 
      reconstitution inflammatory syndrome (IRIS). METHODS: A total of 42 patients with 
      PML underwent a clinical evaluation as well as brain MRI and (1)H-MRS at baseline 
      and 3, 6, and 12 months later. The presence of IRIS was determined based on 
      clinical and laboratory criteria. Ratios of N-acetylaspartate (NAA), choline 
      (Cho), myo-inositol (mI), and lipid/lactate (Lip1 and Lip2) to creatine (Cr) were 
      measured and correlated with the presence of contrast enhancement (CE) in PML 
      lesions. RESULTS: IRIS occurred in 16 of 28 (57.1%) PML survivors (PML-S) and 1 
      of 14 (7.1%) PML progressors (PML-P). Lesions of patients with PML-IRIS showed 
      significantly higher Cho/Cr (p = 0.0001), mI/Cr (p = 0.02), Lip1/Cr (p < 0.0001), 
      and Lip2/Cr (p = 0.002) ratios and lower NAA/Cr (p = 0.02) ratios than patients 
      with PML who did not have IRIS. An elevated Cho/Cr ratio was associated with CE 
      within the (1)H-MRS voxel, whereas lipid/Cr ratios were elevated in PML-IRIS 
      lesions independently of CE. Follow-up until 33 months from PML onset showed 
      persistent elevation of the mI/Cr ratio in lesions of patients with PML-IRIS. A 
      Lip1/Cr ratio greater than 1.5 combined with the presence of CE yielded a 79% 
      probability of IRIS compared with 13% in the absence of these criteria. 
      CONCLUSION: (1)H-MRS is a valuable tool to recognize and track IRIS in PML and 
      may prove useful in the clinical management of these patients.
FAU - Gheuens, Sarah
AU  - Gheuens S
AD  - Division of Neurovirology, Department of Neurology, Beth Israel Deaconess Medical 
      Center, Harvard Medical School, Boston, MA., USA.
FAU - Ngo, Long
AU  - Ngo L
FAU - Wang, Xiaoen
AU  - Wang X
FAU - Alsop, David C
AU  - Alsop DC
FAU - Lenkinski, Robert E
AU  - Lenkinski RE
FAU - Koralnik, Igor J
AU  - Koralnik IJ
LA  - eng
GR  - T32 AI007387/AI/NIAID NIH HHS/United States
GR  - NS047029/NS/NINDS NIH HHS/United States
GR  - MH077073/MH/NIMH NIH HHS/United States
GR  - AG028076,/AG/NIA NIH HHS/United States
GR  - DC008796/DC/NIDCD NIH HHS/United States
GR  - MH80729/MH/NIMH NIH HHS/United States
GR  - AG031720/AG/NIA NIH HHS/United States
GR  - K24-NS060950/NS/NINDS NIH HHS/United States
GR  - CA115745/CA/NCI NIH HHS/United States
GR  - EB004582/EB/NIBIB NIH HHS/United States
GR  - R01 NS047029/NS/NINDS NIH HHS/United States
GR  - DK084463)/DK/NIDDK NIH HHS/United States
GR  - CA101942/CA/NCI NIH HHS/United States
GR  - T32-AI07387-21/AI/NIAID NIH HHS/United States
GR  - R56-NS041198/NS/NINDS NIH HHS/United States
GR  - R01-NS047029/NS/NINDS NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20120822
PL  - United States
TA  - Neurology
JT  - Neurology
JID - 0401060
SB  - IM
MH  - Adult
MH  - Aged
MH  - Brain/*metabolism/pathology
MH  - Female
MH  - HIV Seropositivity/complications/metabolism/pathology
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/complications/*metabolism/pathology
MH  - Leukoencephalopathy, Progressive Multifocal/complications/*metabolism/pathology
MH  - Magnetic Resonance Spectroscopy
MH  - Male
MH  - Middle Aged
PMC - PMC3430711
EDAT- 2012/08/24 06:00
MHDA- 2013/03/22 06:00
PMCR- 2013/09/04
CRDT- 2012/08/24 06:00
PHST- 2012/08/24 06:00 [entrez]
PHST- 2012/08/24 06:00 [pubmed]
PHST- 2013/03/22 06:00 [medline]
PHST- 2013/09/04 00:00 [pmc-release]
AID - WNL.0b013e318268465b [pii]
AID - WNL204103 [pii]
AID - 10.1212/WNL.0b013e318268465b [doi]
PST - ppublish
SO  - Neurology. 2012 Sep 4;79(10):1041-8. doi: 10.1212/WNL.0b013e318268465b. Epub 2012 
      Aug 22.