The chameleon of neuroinflammation: magnetic resonance imaging characteristics of natalizumab-associated progressive multifocal leukoencephalopathy

Natalizumab is a monoclonal antibody against α4-integrin approved for the treatment of multiple sclerosis (MS) due to a positive effect on clinical and magnetic resonance imaging (MRI) outcome measures. However, one relatively rare but serious side effect of this drug is a higher risk of developing...

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Vydáno v:	Multiple sclerosis Ročník 19; číslo 14; s. 1826 - 1840
Hlavní autoři:	Wattjes, Mike P, Richert, Nancy D, Killestein, Joep, de Vos, Marlieke, Sanchez, Esther, Snaebjornsson, Petur, Cadavid, Diego, Barkhof, Frederik
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	London, England SAGE Publications 01.12.2013 Sage Publications Sage Publications Ltd
Témata:	Animals Antibodies, Monoclonal, Humanized - adverse effects Biological and medical sciences Brain - drug effects Brain - pathology Brain - virology Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases Demyelinating Diseases - pathology Diagnosis, Differential Early Diagnosis Human viral diseases Humans Immune Reconstitution Inflammatory Syndrome - chemically induced Immune Reconstitution Inflammatory Syndrome - pathology Immune Reconstitution Inflammatory Syndrome - virology Immunologic Factors - adverse effects Infectious diseases Investigative techniques, diagnostic techniques (general aspects) Leukoencephalopathy, Progressive Multifocal - chemically induced Leukoencephalopathy, Progressive Multifocal - pathology Leukoencephalopathy, Progressive Multifocal - virology Magnetic Resonance Imaging Medical sciences Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis Natalizumab Nervous system Neuroimaging - methods Neurology Predictive Value of Tests Radiodiagnosis. Nmr imagery. Nmr spectrometry Viral diseases Viral diseases of the nervous system Multiple sclerosis magnetic resonance imaging progressive multifocal leukoencephalopathy natalizumab Nervous system diseases Natalizumab Nuclear magnetic resonance imaging Inflammatory disease Cerebral disorder Progressive multifocal leukoencephalopathy Infection Virus Viral disease Central nervous system disease Medical imagery Degenerative disease Slow virus
ISSN:	1352-4585, 1477-0970, 1477-0970
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Abstract	Natalizumab is a monoclonal antibody against α4-integrin approved for the treatment of multiple sclerosis (MS) due to a positive effect on clinical and magnetic resonance imaging (MRI) outcome measures. However, one relatively rare but serious side effect of this drug is a higher risk of developing progressive multifocal leukoencephalopathy (PML). Since the FDA approval, more than 300 natalizumab-associated PML cases have been documented among more than 100,000 treated MS patients. MRI is a crucial tool in the surveillance of patients treated with natalizumab in order to detect possible signs of PML in the asymptomatic stage. Although classical imaging characteristics of PML are well established, MRI findings in natalizumab-associated PML, particularly in early disease stages, show rather new and heterogeneous imaging findings including different patterns of inflammation with contrast enhancement. This review provides a comprehensive overview of the heterogeneous imaging findings in natalizumab-associated PML in the context of the underlying pathophysiology, histopathology, and the diagnostic procedure. We describe the MRI patterns of PML lesion evolution and complications including immune reconstitution inflammatory syndrome (IRIS). Finally, we present guidelines to differentiate MRI findings in PML from inflammatory demyelinating lesions, to facilitate the early diagnosis of PML in patients treated with natalizumab.
AbstractList	Natalizumab is a monoclonal antibody against α4-integrin approved for the treatment of multiple sclerosis (MS) due to a positive effect on clinical and magnetic resonance imaging (MRI) outcome measures. However, one relatively rare but serious side effect of this drug is a higher risk of developing progressive multifocal leukoencephalopathy (PML). Since the FDA approval, more than 300 natalizumab-associated PML cases have been documented among more than 100,000 treated MS patients. MRI is a crucial tool in the surveillance of patients treated with natalizumab in order to detect possible signs of PML in the asymptomatic stage. Although classical imaging characteristics of PML are well established, MRI findings in natalizumab-associated PML, particularly in early disease stages, show rather new and heterogeneous imaging findings including different patterns of inflammation with contrast enhancement. This review provides a comprehensive overview of the heterogeneous imaging findings in natalizumab-associated PML in the context of the underlying pathophysiology, histopathology, and the diagnostic procedure. We describe the MRI patterns of PML lesion evolution and complications including immune reconstitution inflammatory syndrome (IRIS). Finally, we present guidelines to differentiate MRI findings in PML from inflammatory demyelinating lesions, to facilitate the early diagnosis of PML in patients treated with natalizumab.Natalizumab is a monoclonal antibody against α4-integrin approved for the treatment of multiple sclerosis (MS) due to a positive effect on clinical and magnetic resonance imaging (MRI) outcome measures. However, one relatively rare but serious side effect of this drug is a higher risk of developing progressive multifocal leukoencephalopathy (PML). Since the FDA approval, more than 300 natalizumab-associated PML cases have been documented among more than 100,000 treated MS patients. MRI is a crucial tool in the surveillance of patients treated with natalizumab in order to detect possible signs of PML in the asymptomatic stage. Although classical imaging characteristics of PML are well established, MRI findings in natalizumab-associated PML, particularly in early disease stages, show rather new and heterogeneous imaging findings including different patterns of inflammation with contrast enhancement. This review provides a comprehensive overview of the heterogeneous imaging findings in natalizumab-associated PML in the context of the underlying pathophysiology, histopathology, and the diagnostic procedure. We describe the MRI patterns of PML lesion evolution and complications including immune reconstitution inflammatory syndrome (IRIS). Finally, we present guidelines to differentiate MRI findings in PML from inflammatory demyelinating lesions, to facilitate the early diagnosis of PML in patients treated with natalizumab. Natalizumab is a monoclonal antibody against α4-integrin approved for the treatment of multiple sclerosis (MS) due to a positive effect on clinical and magnetic resonance imaging (MRI) outcome measures. However, one relatively rare but serious side effect of this drug is a higher risk of developing progressive multifocal leukoencephalopathy (PML). Since the FDA approval, more than 300 natalizumab-associated PML cases have been documented among more than 100,000 treated MS patients. MRI is a crucial tool in the surveillance of patients treated with natalizumab in order to detect possible signs of PML in the asymptomatic stage. Although classical imaging characteristics of PML are well established, MRI findings in natalizumab-associated PML, particularly in early disease stages, show rather new and heterogeneous imaging findings including different patterns of inflammation with contrast enhancement. This review provides a comprehensive overview of the heterogeneous imaging findings in natalizumab-associated PML in the context of the underlying pathophysiology, histopathology, and the diagnostic procedure. We describe the MRI patterns of PML lesion evolution and complications including immune reconstitution inflammatory syndrome (IRIS). Finally, we present guidelines to differentiate MRI findings in PML from inflammatory demyelinating lesions, to facilitate the early diagnosis of PML in patients treated with natalizumab. Natalizumab is a monoclonal antibody against α4-integrin approved for the treatment of multiple sclerosis (MS) due to a positive effect on clinical and magnetic resonance imaging (MRI) outcome measures. However, one relatively rare but serious side effect of this drug is a higher risk of developing progressive multifocal leukoencephalopathy (PML). Since the FDA approval, more than 300 natalizumab-associated PML cases have been documented among more than 100,000 treated MS patients. MRI is a crucial tool in the surveillance of patients treated with natalizumab in order to detect possible signs of PML in the asymptomatic stage. Although classical imaging characteristics of PML are well established, MRI findings in natalizumab-associated PML, particularly in early disease stages, show rather new and heterogeneous imaging findings including different patterns of inflammation with contrast enhancement. This review provides a comprehensive overview of the heterogeneous imaging findings in natalizumab-associated PML in the context of the underlying pathophysiology, histopathology, and the diagnostic procedure. We describe the MRI patterns of PML lesion evolution and complications including immune reconstitution inflammatory syndrome (IRIS). Finally, we present guidelines to differentiate MRI findings in PML from inflammatory demyelinating lesions, to facilitate the early diagnosis of PML in patients treated with natalizumab. [PUBLICATION ABSTRACT]
Author	Wattjes, Mike P Cadavid, Diego Killestein, Joep Richert, Nancy D de Vos, Marlieke Snaebjornsson, Petur Barkhof, Frederik Sanchez, Esther
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Keywords	Multiple sclerosis magnetic resonance imaging progressive multifocal leukoencephalopathy natalizumab Nervous system diseases Natalizumab Nuclear magnetic resonance imaging Inflammatory disease Cerebral disorder Progressive multifocal leukoencephalopathy Infection Virus Viral disease Central nervous system disease Medical imagery Degenerative disease Slow virus
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Snippet	Natalizumab is a monoclonal antibody against α4-integrin approved for the treatment of multiple sclerosis (MS) due to a positive effect on clinical and...
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SubjectTerms	Animals Antibodies, Monoclonal, Humanized - adverse effects Biological and medical sciences Brain - drug effects Brain - pathology Brain - virology Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases Demyelinating Diseases - pathology Diagnosis, Differential Early Diagnosis Human viral diseases Humans Immune Reconstitution Inflammatory Syndrome - chemically induced Immune Reconstitution Inflammatory Syndrome - pathology Immune Reconstitution Inflammatory Syndrome - virology Immunologic Factors - adverse effects Infectious diseases Investigative techniques, diagnostic techniques (general aspects) Leukoencephalopathy, Progressive Multifocal - chemically induced Leukoencephalopathy, Progressive Multifocal - pathology Leukoencephalopathy, Progressive Multifocal - virology Magnetic Resonance Imaging Medical sciences Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis Natalizumab Nervous system Neuroimaging - methods Neurology Predictive Value of Tests Radiodiagnosis. Nmr imagery. Nmr spectrometry Viral diseases Viral diseases of the nervous system
Title	The chameleon of neuroinflammation: magnetic resonance imaging characteristics of natalizumab-associated progressive multifocal leukoencephalopathy
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