Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA/Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
Mult Scler. 2021 Dec;27(14):2159-2169. doi: 10.1177/1352458521999651. Epub 2021 Mar 22.
Describe magnetic resonance imaging (MRI) susceptibility changes in progressive multifocal leukoencephalopathy (PML) and identify neuropathological correlates.
PML cases and matched controls with primary central nervous system lymphoma (PCNSL) were retrospectively identified. MRI brain at 3 T and 7 T were reviewed. MRI-pathology correlations in fixed brain autopsy tissue were conducted in three subjects with confirmed PML.
With PML ( = 26 total, = 5 multiple sclerosis natalizumab-associated), juxtacortical changes on susceptibility-weighted imaging (SWI) or gradient echo (GRE) sequences were noted in 3/3 cases on 7 T MRI and 14/22 cases (63.6%) on 1.5 T or 8/22 (36.4%) 3 T MRI. Similar findings were only noted in 3/25 (12.0%) of PCNSL patients (odds ratio (OR) 12.83, 95% confidence interval (CI), 2.9-56.7, < 0.001) on 1.5 or 3 T MRI. On susceptibility sequences available prior to diagnosis of PML, 7 (87.5%) had changes present on average 2.7 ± 1.8 months (mean ± SD) prior to diagnosis. Postmortem 7 T MRI showed SWI changes corresponded to areas of increased iron density along the gray-white matter (GM-WM) junction predominantly in macrophages.
Susceptibility changes in PML along the GM-WM junction can precede noticeable fluid-attenuated inversion recovery (FLAIR) changes and correlates with iron accumulation in macrophages.
描述进展性多灶性白质脑病（PML）中的磁共振成像（MRI）磁化率变化，并确定其神经病理学相关性。
回顾性确定 PML 病例和匹配的原发性中枢神经系统淋巴瘤（PCNSL）对照。对 3T 和 7T 的脑部 MRI 进行了回顾性分析。对 3 例确诊为 PML 的患者的固定脑尸检组织进行了 MRI-病理学相关性研究。
在 PML 患者（n=26，n=5 例为多发性硬化症纳他珠单抗相关）中，在 7T MRI 上，3/3 例患者出现皮质下 SWI 或梯度回波（GRE）序列的磁化率变化，在 1.5T 或 3T MRI 上，22 例中有 14 例（63.6%）（n=22）出现磁化率变化，在 3T MRI 上有 8 例（36.4%）（n=22）出现磁化率变化。在 1.5 或 3T MRI 上，仅在 25 例 PCNSL 患者（n=25）中有 3 例（12.0%）出现类似的发现（比值比（OR）为 12.83，95%置信区间（CI）为 2.9-56.7，P<0.001）。在诊断为 PML 之前可获得的磁化率序列上，有 7 例（87.5%）患者的变化平均在诊断前 2.7±1.8 个月（均值±标准差）时出现。7T 磁共振后成像显示，SWI 变化与沿灰质-白质（GM-WM）交界处的铁密度增加区域相对应，主要位于巨噬细胞中。
PML 沿 GM-WM 交界处的磁化率变化可早于明显的液体衰减反转恢复（FLAIR）变化，并与巨噬细胞中铁积累相关。
