7T MRI in natalizumab-associated PML and ongoing MS disease activity: A case study

Tim Sinnecker; Jalal Othman; Marc Kühl; Ralf Mekle; Inga Selbig; Thoralf Niendorf; Annett Kunkel; Peter Wienecke; Peter Kern; Friedemann Paul; Juergen Faiss; Jens Wuerfel

doi:10.1212/NXI.0000000000000171

7T MRI in natalizumab-associated PML and ongoing MS disease activity: A case study

Neurol Neuroimmunol Neuroinflamm. 2015 Oct 29;2(6):e171. doi: 10.1212/NXI.0000000000000171. eCollection 2015 Dec.

Authors

Affiliation

¹ Department of Neurology (T.S., J.O., M.K., I.S., A.K., P.W., P.K., J.F.), Asklepios Fachklinikum Teupitz; NeuroCure Clinical Research Center (T.S., F.P., J.W.), Experimental and Clinical Research Center (T.N., F.P.), Department of Neurology (F.P.), and Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Charité-Universitätsmedizin Berlin; Medical Physics (R.M.), Physikalisch-Technische Bundesanstalt; Berlin Ultrahigh Field Facility (T.N., J.W.) and Experimental and Clinical Research Center (T.N., F.P.), Max Delbrück Center for Molecular Medicine, Berlin; Institute of Neuroradiology (J.W.), Universitätsmedizin Göttingen, Germany; and MIAC AG (J.W.), Basel, Switzerland.

Abstract

Objective: To assess the ability of ultra-high-field MRI to distinguish early progressive multifocal leukoencephalopathy (PML) from multiple sclerosis (MS) lesions in a rare case of simultaneous presentation of natalizumab-associated PML and ongoing MS activity.

Methods: Advanced neuroimaging including 1.5T, 3T, and 7T MRI with a spatial resolution of up to 0.08 mm(3) was performed.

Results: 7T MRI differentiated between PML-related and MS-related brain damage in vivo. Ring-enhancing MS plaques displayed a central vein, whereas confluent PML lesions were preceded by punctate or milky way-like T2 lesions.

Conclusions: Given the importance of early diagnosis of treatment-associated PML, future systematic studies are warranted to assess the value of highly resolving MRI in differentiating between early PML- and MS-induced brain parenchymal lesions.