Division of Neurovirology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA., USA.
Neurology. 2012 Sep 4;79(10):1041-8. doi: 10.1212/WNL.0b013e318268465b. Epub 2012 Aug 22.
To characterize progressive multifocal leukoencephalopathy (PML) lesions by contrast-enhanced MRI and evaluate their metabolism using proton magnetic resonance spectroscopy ((1)H- MRS) in the setting of immune reconstitution inflammatory syndrome (IRIS).
A total of 42 patients with PML underwent a clinical evaluation as well as brain MRI and (1)H-MRS at baseline and 3, 6, and 12 months later. The presence of IRIS was determined based on clinical and laboratory criteria. Ratios of N-acetylaspartate (NAA), choline (Cho), myo-inositol (mI), and lipid/lactate (Lip1 and Lip2) to creatine (Cr) were measured and correlated with the presence of contrast enhancement (CE) in PML lesions.
IRIS occurred in 16 of 28 (57.1%) PML survivors (PML-S) and 1 of 14 (7.1%) PML progressors (PML-P). Lesions of patients with PML-IRIS showed significantly higher Cho/Cr (p = 0.0001), mI/Cr (p = 0.02), Lip1/Cr (p < 0.0001), and Lip2/Cr (p = 0.002) ratios and lower NAA/Cr (p = 0.02) ratios than patients with PML who did not have IRIS. An elevated Cho/Cr ratio was associated with CE within the (1)H-MRS voxel, whereas lipid/Cr ratios were elevated in PML-IRIS lesions independently of CE. Follow-up until 33 months from PML onset showed persistent elevation of the mI/Cr ratio in lesions of patients with PML-IRIS. A Lip1/Cr ratio greater than 1.5 combined with the presence of CE yielded a 79% probability of IRIS compared with 13% in the absence of these criteria.
(1)H-MRS is a valuable tool to recognize and track IRIS in PML and may prove useful in the clinical management of these patients.
通过对比增强 MRI 对进行性多灶性白质脑病 (PML) 病变进行特征描述，并利用质子磁共振波谱 ((1)H-MRS) 对免疫重建炎症综合征 (IRIS) 中的代谢情况进行评估。
共有 42 名 PML 患者接受了临床评估以及脑部 MRI 和 (1)H-MRS 检查，分别在基线时以及 3、6 和 12 个月后进行。根据临床和实验室标准确定 IRIS 的存在。测量 N-乙酰天冬氨酸 (NAA)、胆碱 (Cho)、肌醇 (mI)、脂质/乳酸 (Lip1 和 Lip2) 与肌酸 (Cr) 的比值，并将其与 PML 病变的对比增强 (CE) 相关性进行关联。
28 名 PML 幸存者 (PML-S) 中有 16 名 (57.1%) 和 14 名 PML 进展者 (PML-P) 中的 1 名出现 IRIS。患有 PML-IRIS 的患者的病变显示出更高的 Cho/Cr (p = 0.0001)、mI/Cr (p = 0.02)、Lip1/Cr (p < 0.0001) 和 Lip2/Cr (p = 0.002) 比值和更低的 NAA/Cr (p = 0.02) 比值，与没有发生 IRIS 的患者相比。Cho/Cr 比值升高与 (1)H-MRS 体素内的 CE 相关，而脂质/Cr 比值在 PML-IRIS 病变中独立于 CE 升高。从 PML 发病开始至 33 个月的随访显示，患有 PML-IRIS 的患者的病变中 mI/Cr 比值持续升高。Lip1/Cr 比值大于 1.5 并伴有 CE 的存在，与没有这些标准的情况下相比，IRIS 的概率为 79%，而只有这些标准的情况下为 13%。
(1)H-MRS 是一种识别和跟踪 PML 中 IRIS 的有价值工具，并且可能在这些患者的临床管理中证明有用。
