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#Post#: 1332--------------------------------------------------
(Abst.) MRI criteria differentiating asymptomatic PML from new M
S lesions...
By: agate Date: August 18, 2016, 8:28 pm
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One big problem with PML is that when you have it but you also
have MS, the doctors can't always tell if they're looking at MS
or at PML. But apparently they're figuring it out.
From PubMed, August 18, 2016:
[quote]J Neurol Neurosurg Psychiatry. 2016 Aug 16.
MRI criteria differentiating asymptomatic PML from new MS
lesions during natalizumab pharmacovigilance
Wijburg MT1, Witte BI2, Vennegoor A3, Roosendaal SD4, Sanchez
E5, Liu Y6, Martins Jarnalo CO7, Uitdehaag BM3, Barkhof F5,
Killestein J3, Wattjes MP5.
Author information
1Department of Neurology, Amsterdam Neuroscience, VUmc MS Center
Amsterdam, VU University Medical Center, Amsterdam, The
Netherlands Department of Radiology & Nuclear Medicine,
Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University
Medical Center, Amsterdam, The Netherlands.
2Department of Epidemiology and Biostatistics, VU University
Medical Center, Amsterdam, The Netherlands.
3Department of Neurology, Amsterdam Neuroscience, VUmc MS Center
Amsterdam, VU University Medical Center, Amsterdam, The
Netherlands.
4Department of Radiology & Nuclear Medicine, Amsterdam
Neuroscience, VUmc MS Center Amsterdam, VU University Medical
Center, Amsterdam, The Netherlands Department of Radiology,
Academic Medical Center, Amsterdam, The Netherlands.
5Department of Radiology & Nuclear Medicine, Amsterdam
Neuroscience, VUmc MS Center Amsterdam, VU University Medical
Center, Amsterdam, The Netherlands.
6Department of Radiology & Nuclear Medicine, Amsterdam
Neuroscience, VUmc MS Center Amsterdam, VU University Medical
Center, Amsterdam, The Netherlands Department of Radiology,
Xuanwu Hospital, Capital Medical University, Beijing, P. R.
China.
7Department of Radiology & Nuclear Medicine, Amsterdam
Neuroscience, VUmc MS Center Amsterdam, VU University Medical
Center, Amsterdam, The Netherlands Department of Radiology,
Albert Schweitzer Hospital, Dordrecht, The Netherlands.
OBJECTIVE:
Differentiation between progressive multifocal
leukoencephalopathy (PML) and new multiple sclerosis (MS)
lesions on brain MRI during natalizumab pharmacovigilance in the
absence of clinical signs and symptoms is challenging but is of
substantial clinical relevance. We aim to define MRI
characteristics that can aid in this differentiation.
METHODS:
Reference and follow-up brain MRIs of natalizumab-treated
patients with MS with asymptomatic PML (n=21), or asymptomatic
new MS lesions (n=20) were evaluated with respect to
characteristics of newly detected lesions by four blinded
raters. We tested the association with PML for each
characteristic and constructed a multivariable prediction model
which we analysed using a receiver operating characteristic
(ROC) curve.
RESULTS:
Presence of punctate T2 lesions, cortical grey matter
involvement, juxtacortical white matter involvement, ill-defined
and mixed lesion borders towards both grey and white matter,
lesion size of >3 cm, and contrast enhancement were all
associated with PML. Focal lesion appearance and periventricular
localisation were associated with new MS lesions. In the
multivariable model, punctate T2 lesions and cortical grey
matter involvement predict for PML, while focal lesion
appearance and periventricular localisation predict for new MS
lesions (area under the curve: 0.988, 95% CI 0.977 to 1.0,
sensitivity: 100%, specificity: 80.6%).
INTERPRETATION:
The MRI characteristics of asymptomatic natalizumab-associated
PML lesions proved to differ from new MS lesions. This led to a
prediction model with a high discriminating power. Careful
assessment of the presence of punctate T2 lesions, cortical grey
matter involvement, focal lesion appearance and periventricular
localisation allows for an early diagnosis of PML.[/quote]
This abstract can be seen here
HTML http://www.ncbi.nlm.nih.gov/pubmed/27530808.
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