PMID- 24192217
OWN - NLM
STAT- MEDLINE
DCOM- 20140721
LR  - 20151119
IS  - 1477-0970 (Electronic)
IS  - 1352-4585 (Linking)
VI  - 19
IP  - 14
DP  - 2013 Dec
TI  - The chameleon of neuroinflammation: magnetic resonance imaging characteristics of 
      natalizumab-associated progressive multifocal leukoencephalopathy.
PG  - 1826-40
LID - 10.1177/1352458513510224 [doi]
AB  - Natalizumab is a monoclonal antibody against alpha4-integrin approved for the 
      treatment of multiple sclerosis (MS) due to a positive effect on clinical and 
      magnetic resonance imaging (MRI) outcome measures. However, one relatively rare 
      but serious side effect of this drug is a higher risk of developing progressive 
      multifocal leukoencephalopathy (PML). Since the FDA approval, more than 300 
      natalizumab-associated PML cases have been documented among more than 100,000 
      treated MS patients. MRI is a crucial tool in the surveillance of patients 
      treated with natalizumab in order to detect possible signs of PML in the 
      asymptomatic stage. Although classical imaging characteristics of PML are well 
      established, MRI findings in natalizumab-associated PML, particularly in early 
      disease stages, show rather new and heterogeneous imaging findings including 
      different patterns of inflammation with contrast enhancement. This review 
      provides a comprehensive overview of the heterogeneous imaging findings in 
      natalizumab-associated PML in the context of the underlying pathophysiology, 
      histopathology, and the diagnostic procedure. We describe the MRI patterns of PML 
      lesion evolution and complications including immune reconstitution inflammatory 
      syndrome (IRIS). Finally, we present guidelines to differentiate MRI findings in 
      PML from inflammatory demyelinating lesions, to facilitate the early diagnosis of 
      PML in patients treated with natalizumab.
FAU - Wattjes, Mike P
AU  - Wattjes MP
AD  - Department of Radiology, Nuclear Medicine & PET Research, University Medical 
      Center, The Netherlands.
FAU - Richert, Nancy D
AU  - Richert ND
FAU - Killestein, Joep
AU  - Killestein J
FAU - de Vos, Marlieke
AU  - de Vos M
FAU - Sanchez, Esther
AU  - Sanchez E
FAU - Snaebjornsson, Petur
AU  - Snaebjornsson P
FAU - Cadavid, Diego
AU  - Cadavid D
FAU - Barkhof, Frederik
AU  - Barkhof F
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
DEP - 20131105
PL  - England
TA  - Mult Scler
JT  - Multiple sclerosis (Houndmills, Basingstoke, England)
JID - 9509185
RN  - 0 (Antibodies, Monoclonal, Humanized)
RN  - 0 (Immunologic Factors)
RN  - 0 (Natalizumab)
SB  - IM
MH  - Animals
MH  - Antibodies, Monoclonal, Humanized/*adverse effects
MH  - Brain/drug effects/*pathology/virology
MH  - Demyelinating Diseases/pathology
MH  - Diagnosis, Differential
MH  - Early Diagnosis
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/chemically induced/pathology/virology
MH  - Immunologic Factors/*adverse effects
MH  - Leukoencephalopathy, Progressive Multifocal/chemically 
      induced/*pathology/virology
MH  - *Magnetic Resonance Imaging
MH  - Natalizumab
MH  - Neuroimaging/*methods
MH  - Predictive Value of Tests
OTO - NOTNLM
OT  - Multiple sclerosis
OT  - magnetic resonance imaging
OT  - natalizumab
OT  - progressive multifocal leukoencephalopathy
EDAT- 2013/11/07 06:00
MHDA- 2014/07/22 06:00
CRDT- 2013/11/07 06:00
PHST- 2013/11/07 06:00 [entrez]
PHST- 2013/11/07 06:00 [pubmed]
PHST- 2014/07/22 06:00 [medline]
AID - 1352458513510224 [pii]
AID - 10.1177/1352458513510224 [doi]
PST - ppublish
SO  - Mult Scler. 2013 Dec;19(14):1826-40. doi: 10.1177/1352458513510224. Epub 2013 Nov 
      5.