Progressive multifocal leukoencephalopathy: MRI findings in HIV-infected patients are closer to rituximab- than natalizu
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NEURO
Progressive multifocal leukoencephalopathy: MRI findings in HIV-infected patients are closer to rituximab- than natalizumab-associated PML Manel Alleg 1 & Morgane Solis 2 & Seyyid Baloglu 1 & François Cotton 3,4 & Philippe Kerschen 5 & Bertrand Bourre 6 & Guido Ahle 7 & Jean-Pierre Pruvo 8 & Xavier Leclerc 8 & Patrick Vermersch 9 & Caroline Papeix 10 & Élisabeth Maillart 10 & Caroline Houillier 11 & Cécile Moluçon Chabrot 12 & Béatrice Claise 12 & Sandra Malak 13 & Guillaume Martin-Blondel 14,15 & Fabrice Bonneville 16 & Alexis Caulier 17 & Jean-Pierre Marolleau 17 & Jérôme Tamburini Bonnefoy 18 & Philippe Agape 19 & Céline Kennel 20 & Xavier Roussel 21 & Adrien Chauchet 21 & Jérôme De Seze 22 & Samira Fafi-Kremer 2 & Stéphane Kremer 1,23 Received: 25 January 2020 / Revised: 26 August 2020 / Accepted: 29 September 2020 # European Society of Radiology 2020
Abstract Objectives To compare brain MRI findings in progressive multifocal leukoencephalopathy (PML) associated to rituximab and natalizumab treatments and HIV infection. Materials and methods In this retrospective, multicentric study, we analyzed brain MRI exams from 72 patients diagnosed with definite PML: 32 after natalizumab treatment, 20 after rituximab treatment, and 20 HIV patients. We compared T2- or FLAIRweighted images, diffusion-weighted images, T2*-weighted images, and contrast enhancement features, as well as lesion distribution, especially gray matter involvement. Results The three PML entities affect U-fibers associated with low signal intensities on T2*-weighted sequences. Natalizumabassociated PML showed a punctuate microcystic appearance in or in the vicinity of the main PML lesions, a potential involvement of the cortex, and contrast enhancement. HIV and rituximab-associated PML showed only mild contrast enhancement,
* Manel Alleg [email protected]
11
APHP, Sorbonne Université, IHU, ICM, Service de Neurologie 2-Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
12
CHU de Clermont Ferrand, Clermont Ferrand, France
1
Hôpitaux Universitaires de Strasbourg, Service d’imagerie 2, Hôpital de Hautepierre, Strasbourg, France
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Service d’hématologie, Institut Curie-Saint-Cloud, Saint-Cloud, France
2
Hôpitaux universitaires de Strasbourg, Laboratoire de Virologie Médicale, Strasbourg, France
14
Service des Maladies Infectieuses et Tropicales, CHU de Toulouse, Toulouse, France
3
MRI center, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon,, Lyon, France
15
UMR INSERM/CNRS 1043, Centre de Physiopathologie Toulouse Purpan, Toulouse, France
4
Université Lyon 1, CREATIS-LRMN, CNRS/UMR/5220-INSERM U630, Villeurbanne, France
16
Service de Neuroradiologie, CHU de Toulouse, Toulouse, France
17
Hématologie Clinique, CHU Amiens-Picardie, Amiens, France
5
Centre hospitalier de Luxembourg, Luxembourg City, Luxembourg
18
Hôpital Cochin Paris, Paris, France
6
Rouen University Hospital, F-76000 Rouen, France
19
Institut de Cancérologie de l’Ouest , Saint-Herblain Nantes, France
7
Service de Neurologie, Hôpitaux
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