PMID- 27009257
OWN - NLM
STAT- MEDLINE
DCOM- 20170428
LR  - 20220317
IS  - 1526-632X (Electronic)
IS  - 0028-3878 (Linking)
VI  - 86
IP  - 16
DP  - 2016 Apr 19
TI  - Punctate pattern: A promising imaging marker for the diagnosis of 
      natalizumab-associated PML.
PG  - 1516-23
LID - 10.1212/WNL.0000000000002586 [doi]
AB  - OBJECTIVE: To evaluate the usefulness of the punctate pattern (PP) for the 
      diagnosis and follow-up of patients with progressive multifocal 
      leukoencephalopathy (PML). METHODS: A cohort of 20 consecutive patients with PML, 
      related to natalizumab (NTZ) (n = 14) or not (n = 6), underwent 3T MRI (147 MRI 
      examinations). MRI was available at presymptomatic (n = 9 patients), symptomatic 
      (n = 15), immune reconstitution inflammatory syndrome (IRIS), and chronic stages 
      (n = 20). A pathologic control group of patients without PML (n = 80), with 
      clinically definitive multiple sclerosis or a clinically isolated syndrome 
      suggestive of CNS demyelination, underwent the same MRI protocol. Number and 
      appearance of punctate lesions were assessed by 3 blinded readers using 
      T2-weighted, fluid-attenuated inversion recovery (FLAIR), and postcontrast 
      T1-weighted images. RESULTS: Interobserver agreement was good (kappa = 0.79) 
      (0.72-0.87). Of the 20 patients with PML, 18 had PP, including the 14 patients 
      with NTZ-PML; none in the pathologic control group. Of the 9 presymptomatic 
      patients with NTZ-PML, PP was observed in 7 (78% sensitive and 100% specific). 
      Nonenhancing PP on T2-weighted/FLAIR images was detected in 13 patients with PML, 
      exclusively at the presymptomatic or symptomatic stages (including 7 NTZ-PML), 
      whereas enhancing PP occurred in 16 patients with PML, including 13 of the 14 
      patients with NTZ-PML at the IRIS stage. CONCLUSIONS: PP is a highly specific 
      feature of PML and may be the first imaging feature at the presymptomatic stage 
      with potential implications in patient care. CLASSIFICATION OF EVIDENCE: This 
      study provides Class II evidence that a PP on MRI accurately identifies patients 
      with NTZ-PML.
CI  - (c) 2016 American Academy of Neurology.
FAU - Hodel, Jerome
AU  - Hodel J
AD  - From the University of Lille, CHU Lille (J.H., C.D., O.O., V.D., A.L., J.P.P., 
      P.V., X.L.), Lille, France; Departments of Neuroradiology (J.H., C.D., J.P.P., 
      X.L.), Pathology (V.D.) and Neurology (O.O., A.L., P.V.), Hopital Roger Salengro, 
      Rue Emile Laine 59037 Lille, France; Department of Radiology (S.V.), Hopital 
      Saint Philibert, Lille, France; Department of Neuroradiology (J.H.), AP-HP, 
      Hopitaux Universitaires Henri Mondor, Creteil, France; Faculty of Medicine 
      (J.H.), Universite Paris Est Creteil, Creteil, France; and Department of 
      Radiology (M.Z.), Hopital Saint Joseph, Paris, France. Jerome.hodel@gmail.com.
FAU - Darchis, Christine
AU  - Darchis C
AD  - From the University of Lille, CHU Lille (J.H., C.D., O.O., V.D., A.L., J.P.P., 
      P.V., X.L.), Lille, France; Departments of Neuroradiology (J.H., C.D., J.P.P., 
      X.L.), Pathology (V.D.) and Neurology (O.O., A.L., P.V.), Hopital Roger Salengro, 
      Rue Emile Laine 59037 Lille, France; Department of Radiology (S.V.), Hopital 
      Saint Philibert, Lille, France; Department of Neuroradiology (J.H.), AP-HP, 
      Hopitaux Universitaires Henri Mondor, Creteil, France; Faculty of Medicine 
      (J.H.), Universite Paris Est Creteil, Creteil, France; and Department of 
      Radiology (M.Z.), Hopital Saint Joseph, Paris, France.
FAU - Outteryck, Olivier
AU  - Outteryck O
AD  - From the University of Lille, CHU Lille (J.H., C.D., O.O., V.D., A.L., J.P.P., 
      P.V., X.L.), Lille, France; Departments of Neuroradiology (J.H., C.D., J.P.P., 
      X.L.), Pathology (V.D.) and Neurology (O.O., A.L., P.V.), Hopital Roger Salengro, 
      Rue Emile Laine 59037 Lille, France; Department of Radiology (S.V.), Hopital 
      Saint Philibert, Lille, France; Department of Neuroradiology (J.H.), AP-HP, 
      Hopitaux Universitaires Henri Mondor, Creteil, France; Faculty of Medicine 
      (J.H.), Universite Paris Est Creteil, Creteil, France; and Department of 
      Radiology (M.Z.), Hopital Saint Joseph, Paris, France.
FAU - Verclytte, Sebastien
AU  - Verclytte S
AD  - From the University of Lille, CHU Lille (J.H., C.D., O.O., V.D., A.L., J.P.P., 
      P.V., X.L.), Lille, France; Departments of Neuroradiology (J.H., C.D., J.P.P., 
      X.L.), Pathology (V.D.) and Neurology (O.O., A.L., P.V.), Hopital Roger Salengro, 
      Rue Emile Laine 59037 Lille, France; Department of Radiology (S.V.), Hopital 
      Saint Philibert, Lille, France; Department of Neuroradiology (J.H.), AP-HP, 
      Hopitaux Universitaires Henri Mondor, Creteil, France; Faculty of Medicine 
      (J.H.), Universite Paris Est Creteil, Creteil, France; and Department of 
      Radiology (M.Z.), Hopital Saint Joseph, Paris, France.
FAU - Deramecourt, Vincent
AU  - Deramecourt V
AD  - From the University of Lille, CHU Lille (J.H., C.D., O.O., V.D., A.L., J.P.P., 
      P.V., X.L.), Lille, France; Departments of Neuroradiology (J.H., C.D., J.P.P., 
      X.L.), Pathology (V.D.) and Neurology (O.O., A.L., P.V.), Hopital Roger Salengro, 
      Rue Emile Laine 59037 Lille, France; Department of Radiology (S.V.), Hopital 
      Saint Philibert, Lille, France; Department of Neuroradiology (J.H.), AP-HP, 
      Hopitaux Universitaires Henri Mondor, Creteil, France; Faculty of Medicine 
      (J.H.), Universite Paris Est Creteil, Creteil, France; and Department of 
      Radiology (M.Z.), Hopital Saint Joseph, Paris, France.
FAU - Lacour, Arnaud
AU  - Lacour A
AD  - From the University of Lille, CHU Lille (J.H., C.D., O.O., V.D., A.L., J.P.P., 
      P.V., X.L.), Lille, France; Departments of Neuroradiology (J.H., C.D., J.P.P., 
      X.L.), Pathology (V.D.) and Neurology (O.O., A.L., P.V.), Hopital Roger Salengro, 
      Rue Emile Laine 59037 Lille, France; Department of Radiology (S.V.), Hopital 
      Saint Philibert, Lille, France; Department of Neuroradiology (J.H.), AP-HP, 
      Hopitaux Universitaires Henri Mondor, Creteil, France; Faculty of Medicine 
      (J.H.), Universite Paris Est Creteil, Creteil, France; and Department of 
      Radiology (M.Z.), Hopital Saint Joseph, Paris, France.
FAU - Zins, Marc
AU  - Zins M
AD  - From the University of Lille, CHU Lille (J.H., C.D., O.O., V.D., A.L., J.P.P., 
      P.V., X.L.), Lille, France; Departments of Neuroradiology (J.H., C.D., J.P.P., 
      X.L.), Pathology (V.D.) and Neurology (O.O., A.L., P.V.), Hopital Roger Salengro, 
      Rue Emile Laine 59037 Lille, France; Department of Radiology (S.V.), Hopital 
      Saint Philibert, Lille, France; Department of Neuroradiology (J.H.), AP-HP, 
      Hopitaux Universitaires Henri Mondor, Creteil, France; Faculty of Medicine 
      (J.H.), Universite Paris Est Creteil, Creteil, France; and Department of 
      Radiology (M.Z.), Hopital Saint Joseph, Paris, France.
FAU - Pruvo, Jean-Pierre
AU  - Pruvo JP
AD  - From the University of Lille, CHU Lille (J.H., C.D., O.O., V.D., A.L., J.P.P., 
      P.V., X.L.), Lille, France; Departments of Neuroradiology (J.H., C.D., J.P.P., 
      X.L.), Pathology (V.D.) and Neurology (O.O., A.L., P.V.), Hopital Roger Salengro, 
      Rue Emile Laine 59037 Lille, France; Department of Radiology (S.V.), Hopital 
      Saint Philibert, Lille, France; Department of Neuroradiology (J.H.), AP-HP, 
      Hopitaux Universitaires Henri Mondor, Creteil, France; Faculty of Medicine 
      (J.H.), Universite Paris Est Creteil, Creteil, France; and Department of 
      Radiology (M.Z.), Hopital Saint Joseph, Paris, France.
FAU - Vermersch, Patrick
AU  - Vermersch P
AD  - From the University of Lille, CHU Lille (J.H., C.D., O.O., V.D., A.L., J.P.P., 
      P.V., X.L.), Lille, France; Departments of Neuroradiology (J.H., C.D., J.P.P., 
      X.L.), Pathology (V.D.) and Neurology (O.O., A.L., P.V.), Hopital Roger Salengro, 
      Rue Emile Laine 59037 Lille, France; Department of Radiology (S.V.), Hopital 
      Saint Philibert, Lille, France; Department of Neuroradiology (J.H.), AP-HP, 
      Hopitaux Universitaires Henri Mondor, Creteil, France; Faculty of Medicine 
      (J.H.), Universite Paris Est Creteil, Creteil, France; and Department of 
      Radiology (M.Z.), Hopital Saint Joseph, Paris, France.
FAU - Leclerc, Xavier
AU  - Leclerc X
AD  - From the University of Lille, CHU Lille (J.H., C.D., O.O., V.D., A.L., J.P.P., 
      P.V., X.L.), Lille, France; Departments of Neuroradiology (J.H., C.D., J.P.P., 
      X.L.), Pathology (V.D.) and Neurology (O.O., A.L., P.V.), Hopital Roger Salengro, 
      Rue Emile Laine 59037 Lille, France; Department of Radiology (S.V.), Hopital 
      Saint Philibert, Lille, France; Department of Neuroradiology (J.H.), AP-HP, 
      Hopitaux Universitaires Henri Mondor, Creteil, France; Faculty of Medicine 
      (J.H.), Universite Paris Est Creteil, Creteil, France; and Department of 
      Radiology (M.Z.), Hopital Saint Joseph, Paris, France.
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
DEP - 20160323
PL  - United States
TA  - Neurology
JT  - Neurology
JID - 0401060
RN  - 0 (DNA, Viral)
RN  - 0 (Immunologic Factors)
RN  - 0 (Natalizumab)
SB  - IM
MH  - Adult
MH  - Aftercare
MH  - Aged
MH  - Brain/*diagnostic imaging/drug effects
MH  - Cohort Studies
MH  - DNA, Viral/cerebrospinal fluid
MH  - Female
MH  - Humans
MH  - Immunologic Factors/*adverse effects/therapeutic use
MH  - JC Virus
MH  - Leukoencephalopathy, Progressive Multifocal/cerebrospinal fluid/*diagnostic 
      imaging/*etiology/therapy
MH  - Magnetic Resonance Imaging/*methods
MH  - Male
MH  - Middle Aged
MH  - Multiple Sclerosis, Relapsing-Remitting/cerebrospinal fluid/diagnostic 
      imaging/drug therapy
MH  - Natalizumab/*adverse effects/therapeutic use
MH  - Observer Variation
MH  - Retrospective Studies
MH  - Sensitivity and Specificity
MH  - Severity of Illness Index
EDAT- 2016/03/25 06:00
MHDA- 2017/04/30 06:00
CRDT- 2016/03/25 06:00
PHST- 2015/06/26 00:00 [received]
PHST- 2016/01/07 00:00 [accepted]
PHST- 2016/03/25 06:00 [entrez]
PHST- 2016/03/25 06:00 [pubmed]
PHST- 2017/04/30 06:00 [medline]
AID - WNL.0000000000002586 [pii]
AID - 10.1212/WNL.0000000000002586 [doi]
PST - ppublish
SO  - Neurology. 2016 Apr 19;86(16):1516-23. doi: 10.1212/WNL.0000000000002586. Epub 
      2016 Mar 23.