PMID- 26369555 OWN - NLM STAT- MEDLINE DCOM- 20170525 LR - 20220409 IS - 1468-330X (Electronic) IS - 0022-3050 (Linking) VI - 87 IP - 8 DP - 2016 Aug TI - MRI characteristics of early PML-IRIS after natalizumab treatment in patients with MS. PG - 879-84 LID - 10.1136/jnnp-2015-311411 [doi] AB - 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. CI - 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/ FAU - Wattjes, Mike P AU - Wattjes MP AD - MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands. FAU - Wijburg, Martijn T AU - Wijburg MT AD - 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. FAU - Vennegoor, Anke AU - Vennegoor A AD - MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands. FAU - Witte, Birgit I AU - Witte BI AD - Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands. FAU - de Vos, Marlieke AU - de Vos M AD - MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands. FAU - Richert, Nancy D AU - Richert ND AD - Multiple Sclerosis Clinical Development Group, Biogen, Cambridge, Massachusetts, USA. FAU - Uitdehaag, Bernard M J AU - Uitdehaag BM AD - MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands. FAU - Barkhof, Frederik AU - Barkhof F AD - MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands. FAU - Killestein, Joep AU - Killestein J AD - MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands. CN - Dutch-Belgian Natalizumab-associated PML study group LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20150914 PL - England TA - J Neurol Neurosurg Psychiatry JT - Journal of neurology, neurosurgery, and psychiatry JID - 2985191R RN - 0 (Natalizumab) SB - IM MH - Adult MH - Aged MH - Female MH - Humans MH - Immune Reconstitution Inflammatory Syndrome/*chemically induced/complications/*diagnostic imaging MH - Leukoencephalopathy, Progressive Multifocal/*chemically induced/complications/*diagnostic imaging MH - Magnetic Resonance Imaging MH - Male MH - Middle Aged MH - Multiple Sclerosis/complications/diagnostic imaging/*drug therapy MH - Natalizumab/*adverse effects/*therapeutic use MH - Neuroimaging MH - Retrospective Studies FIR - van Oosten, Bob W IR - van Oosten BW FIR - Polman, Chris H IR - Polman CH FIR - Siepman, Dorine A IR - Siepman DA FIR - Hintzen, Rogier IR - Hintzen R FIR - Mostert, Jop IR - Mostert J FIR - Moll, Wibe IR - Moll W FIR - van Golde, Alex El IR - van Golde AE FIR - Frequin, Stephan Tfm IR - Frequin ST FIR - Bouma, Paul Ad IR - Bouma PA FIR - Quivron, Benedicte IR - Quivron B FIR - Braeckeveldt, Jean IR - Braeckeveldt J FIR - Munster, Erik van IR - Munster Ev FIR - Eijk, Jeroen van IR - Eijk Jv FIR - Heersema, Thea IR - Heersema T FIR - Graaf, Jaap de IR - Graaf Jd EDAT- 2015/09/16 06:00 MHDA- 2017/05/26 06:00 CRDT- 2015/09/16 06:00 PHST- 2015/05/30 00:00 [received] PHST- 2015/08/26 00:00 [accepted] PHST- 2015/09/16 06:00 [entrez] PHST- 2015/09/16 06:00 [pubmed] PHST- 2017/05/26 06:00 [medline] AID - jnnp-2015-311411 [pii] AID - 10.1136/jnnp-2015-311411 [doi] PST - ppublish SO - J Neurol Neurosurg Psychiatry. 2016 Aug;87(8):879-84. doi: 10.1136/jnnp-2015-311411. Epub 2015 Sep 14.