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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Veröffentlicht in:Multiple sclerosis Jg. 19; H. 14; S. 1826 - 1840
Hauptverfasser: Wattjes, Mike P, Richert, Nancy D, Killestein, Joep, de Vos, Marlieke, Sanchez, Esther, Snaebjornsson, Petur, Cadavid, Diego, Barkhof, Frederik
Format: Journal Article
Sprache:Englisch
Veröffentlicht: London, England SAGE Publications 01.12.2013
Sage Publications
Sage Publications Ltd
Schlagworte:
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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Zusammenfassung: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.
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ISSN:1352-4585
1477-0970
1477-0970
DOI:10.1177/1352458513510224