López Sala P, Alberdi Aldasoro N, Zelaya Huerta M V, Bacaicoa Saralegui M C, Cabada Giadás T
Servicio de Radiodiagnóstico, Complejo Hospitalario de Navarra, Pamplona, Navarra, España.
Servicio de Radiodiagnóstico, Complejo Hospitalario de Navarra, Pamplona, Navarra, España.
Radiologia (Engl Ed). 2020 Jan-Feb;62(1):59-66. doi: 10.1016/j.rx.2019.06.003. Epub 2019 Jul 30.
Progressive multifocal leukoencephalopathy is a demyelinating disease of the central nervous system caused by the reactivation of the JC virus. This opportunistic encephalopathy mainly affects immunodepressed patients with stage III HIV infection, although in recent years it has also been found in association with treatment with immunosuppressors such as natalizumab. MRI plays an important role in both the early diagnosis and follow-up of this disease. Recently, it has been reported that hypointensities in U-fibers and cortex adjacent to white-matter lesions characteristic of the disease can be identified on T2-weighted gradient-echo and susceptibility-weighted sequences in patients with progressive multifocal leukoencephalopathy.
We aimed to analyze the presence and usefulness of cortical hypointensity on T2-weighted gradient-echo sequences in relation to the diagnosis of progressive multifocal leukoencephalopathy and to review the literature on the topic.
We analyze three cases of progressive multifocal leukoencephalopathy seen at our center in three patients with immunosuppression of different origins: one with stage III HIV infection, one with multiple sclerosis being treated with natalizumab, and one with rheumatoid arthritis being treated with rituximab.
In all three cases MRI showed the cortical hypointensity adjacent to the white-matter lesion in the T2-weighted gradient-echo sequence. In the patient with multiple sclerosis, this sign appeared earlier than the abnormal signal in the white matter. The patient being treated with rituximab was diagnosed postmortem and the pathology findings correlated with the MRI findings.
The finding of cortical hypointensity on T2-weighted gradient-echo MRI sequences seems to support the diagnosis of progressive multifocal leukoencephalopathy, regardless of the type of immunosuppression, so this finding should routinely assessed in patients suspected of having this disease.
进行性多灶性白质脑病是一种由JC病毒重新激活引起的中枢神经系统脱髓鞘疾病。这种机会性脑病主要影响处于HIV感染III期的免疫抑制患者，尽管近年来也发现其与诸如那他珠单抗等免疫抑制剂的治疗有关。MRI在该疾病的早期诊断和随访中均发挥着重要作用。最近，有报道称，在进行性多灶性白质脑病患者的T2加权梯度回波序列和磁敏感加权序列上，可以识别出与该疾病特征性白质病变相邻的U纤维和皮质中的低信号。
我们旨在分析T2加权梯度回波序列上皮质低信号在进行性多灶性白质脑病诊断中的存在情况及实用性，并回顾该主题的相关文献。
我们分析了在我们中心就诊的3例进行性多灶性白质脑病病例，这3例患者免疫抑制的病因各不相同：1例为HIV感染III期患者，1例为接受那他珠单抗治疗的多发性硬化患者，1例为接受利妥昔单抗治疗的类风湿关节炎患者。
在所有3例病例中，MRI在T2加权梯度回波序列上均显示出与白质病变相邻的皮质低信号。在多发性硬化患者中，该征象比白质中的异常信号出现得更早。接受利妥昔单抗治疗的患者经尸检确诊，病理结果与MRI结果相符。
T2加权梯度回波MRI序列上皮质低信号的发现似乎支持进行性多灶性白质脑病的诊断，无论免疫抑制的类型如何，因此对于疑似患有该疾病的患者，应常规评估这一发现。
