PMID- 28674518
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200930
IS  - 1664-2295 (Print)
IS  - 1664-2295 (Electronic)
IS  - 1664-2295 (Linking)
VI  - 8
DP  - 2017
TI  - Brain Susceptibility Changes in a Patient with Natalizumab-Related Progressive 
      Multifocal Leukoencephalopathy: A Longitudinal Quantitative Susceptibility 
      Mapping and Relaxometry Study.
PG  - 294
LID - 10.3389/fneur.2017.00294 [doi]
LID - 294
AB  - BACKGROUND: Brain MRI plays an essential role in both diagnosis and follow-up of 
      the JC virus infection of the brain. Recently, MR studies with 
      susceptibility-weighted imaging (SWI) sequences have shown hypointensities in 
      U-fibers adjacent to white matter (WM) lesions of progressive multifocal 
      leukoencephalopathy (PML). This finding has been confirmed with the use of 
      quantitative susceptibility mapping (QSM), allowing to hypothesize a paramagnetic 
      effect in these regions. Here, we report the first longitudinal assessment of QSM 
      and R2* maps in natalizumab-associated PML to evaluate serial changes in 
      susceptibility contrast images and their role in PML diagnosis and follow-up. 
      CASE PRESENTATION: We report the case of a 42-year-old woman with multiple 
      sclerosis (MS) who eventually developed, after the 28th natalizumab infusion, 
      subacute cognitive decline and received a laboratory-confirmed diagnosis of PML, 
      leading to immediate drug discontinuation. Three months later, she suffered a new 
      clinical exacerbation, with a brain scan revealing significant inflammatory 
      activity compatible with the radiological diagnosis of an Immune Reconstitution 
      Inflammatory Syndrome (IRIS). She was then treated with corticosteroids until the 
      clinico-radiological spectrum became stable, with the final outcome of a severe 
      functional impairment. Quantitative maps obtained in the early symptomatic stage 
      clearly showed increased QSM and R2* values in the juxtacortical WM adjacent to 
      PML lesions, which persisted during the subsequent disease course. DISCUSSION AND 
      CONCLUSION: High QSM and R2* values in U-fibers adjacent to WM lesions were early 
      and seemingly time-independent radiological findings in the presented PML case. 
      This, coupled to the known absence of significant paramagnetic effect of new 
      active MS lesions, could support the use of quantitative MRI as an additional 
      tool in the diagnosis and follow-up of natalizumab-related PML in MS.
FAU - Pontillo, Giuseppe
AU  - Pontillo G
AD  - Department of Advanced Biomedical Sciences, University "Federico II", Naples, 
      Italy.
FAU - Cocozza, Sirio
AU  - Cocozza S
AD  - Department of Advanced Biomedical Sciences, University "Federico II", Naples, 
      Italy.
FAU - Lanzillo, Roberta
AU  - Lanzillo R
AD  - Department of Neurosciences, Reproductive and Odontostomatological Sciences, 
      University "Federico II", Naples, Italy.
FAU - Borrelli, Pasquale
AU  - Borrelli P
AD  - IRCCS SDN, Naples, Italy.
FAU - De Rosa, Anna
AU  - De Rosa A
AD  - Department of Neurosciences, Reproductive and Odontostomatological Sciences, 
      University "Federico II", Naples, Italy.
FAU - Brescia Morra, Vincenzo
AU  - Brescia Morra V
AD  - Department of Neurosciences, Reproductive and Odontostomatological Sciences, 
      University "Federico II", Naples, Italy.
FAU - Tedeschi, Enrico
AU  - Tedeschi E
AD  - Department of Advanced Biomedical Sciences, University "Federico II", Naples, 
      Italy.
FAU - Palma, Giuseppe
AU  - Palma G
AD  - Institute of Biostructure and Bioimaging, National Research Council, Naples, 
      Italy.
LA  - eng
PT  - Case Reports
DEP - 20170619
PL  - Switzerland
TA  - Front Neurol
JT  - Frontiers in neurology
JID - 101546899
PMC - PMC5474681
OTO - NOTNLM
OT  - MRI
OT  - multiple sclerosis
OT  - neuroimmunology
OT  - neuroinflammation
OT  - progressive multifocal leukoencephalopathy
OT  - susceptibility-weighted imaging
EDAT- 2017/07/05 06:00
MHDA- 2017/07/05 06:01
PMCR- 2017/06/19
CRDT- 2017/07/05 06:00
PHST- 2017/03/24 00:00 [received]
PHST- 2017/06/07 00:00 [accepted]
PHST- 2017/07/05 06:00 [entrez]
PHST- 2017/07/05 06:00 [pubmed]
PHST- 2017/07/05 06:01 [medline]
PHST- 2017/06/19 00:00 [pmc-release]
AID - 10.3389/fneur.2017.00294 [doi]
PST - epublish
SO  - Front Neurol. 2017 Jun 19;8:294. doi: 10.3389/fneur.2017.00294. eCollection 2017.