Progressive multifocal leukoencephalopathy and relapsing-remitting multiple sclerosis

A comparative study

Aaron Boster, Stephanie Hreha, Joseph R. Berger, Fen Bao, Ramya Penmesta, Alexandros Tselis, Christina Endress, Imad Zak, Jai Perumal, Christina Caon, Jose Antonio Vazquez, Kenneth L. Tyler, Michael K. Racke, Scott Millis, Omar Khan

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Objective: To identify clinical and magnetic resonance imaging (MRI) features that distinguish progressive multifocal leukoencephalopathy (PML) from relapsing-remitting multiple sclerosis (RRMS). Design: Retrospective medical record review. Setting: Two urban teaching hospitals in Detroit, Michigan. Patients: Forty-five confirmed PML cases and 100 patients with RRMS. Main Outcome Measures: Clinical and MRI features distinguishing PML from RRMS. Results: Overall, monosymptomatic presentations were more common in multiple sclerosis (MS) than PML (85% vs 47%; P<.01). However, patients with PML presented more often with hemiparesis (24% vs 5%; P=.001) and altered mentation (19% vs 0%; P<.0001), whereas brainstem (2% vs 18%; P=.007) presentations were more common in patients with RRMS. Spinal cord and optic neuritis presentations were seen in 18% and 33% of patients patients with RRMS, respectively, but not in patients with PML (P<.0001). Brain MRI scans, available in 35 (78%) PML cases, revealed 7 lesion types. Large, confluent T2-weighted lesions (74% vs 2%; P<.0001) and deep gray matter lesions (31% vs 7%; P<.001) were more frequent in patients with PML than patients with RRMS. Crescentic cerebellar lesions (23% vs 0%; P<.001) were seen only in patients with PML. Gadolinium-enhancing (23%), transcallosal (9%), and periventricular (9%) lesions were noted in patients with PML. Brain magnetization transfer ratio (MTR) was low in both PML and MS lesions. However, normal-appearing brain tissue MTR in PML was higher than normal-appearing brain tissue MTR in RRMS (44.15% vs 41.04%; P=.002), suggesting that PML may be relatively more focal than MS. Conclusions: There appear to be differences between the clinical and MRI characteristics of PML and RRMS, which may help distinguish new MS activity from PML. Magnetization transfer ratio studies may provide additional clues in improving early detection of PML in patients with preexisting MS and warrant further investigation.

Original languageEnglish (US)
Pages (from-to)593-599
Number of pages7
JournalArchives of Neurology
Volume66
Issue number5
DOIs
StatePublished - May 1 2009
Externally publishedYes

Fingerprint

Progressive Multifocal Leukoencephalopathy
Relapsing-Remitting Multiple Sclerosis
Multiple Sclerosis
Magnetic Resonance Imaging
Comparative Study
Brain
Optic Neuritis
Urban Hospitals
Gadolinium

ASJC Scopus subject areas

  • Arts and Humanities (miscellaneous)
  • Clinical Neurology

Cite this

Boster, A., Hreha, S., Berger, J. R., Bao, F., Penmesta, R., Tselis, A., ... Khan, O. (2009). Progressive multifocal leukoencephalopathy and relapsing-remitting multiple sclerosis: A comparative study. Archives of Neurology, 66(5), 593-599. https://doi.org/10.1001/archneurol.2009.31

Progressive multifocal leukoencephalopathy and relapsing-remitting multiple sclerosis : A comparative study. / Boster, Aaron; Hreha, Stephanie; Berger, Joseph R.; Bao, Fen; Penmesta, Ramya; Tselis, Alexandros; Endress, Christina; Zak, Imad; Perumal, Jai; Caon, Christina; Vazquez, Jose Antonio; Tyler, Kenneth L.; Racke, Michael K.; Millis, Scott; Khan, Omar.

In: Archives of Neurology, Vol. 66, No. 5, 01.05.2009, p. 593-599.

Research output: Contribution to journalArticle

Boster, A, Hreha, S, Berger, JR, Bao, F, Penmesta, R, Tselis, A, Endress, C, Zak, I, Perumal, J, Caon, C, Vazquez, JA, Tyler, KL, Racke, MK, Millis, S & Khan, O 2009, 'Progressive multifocal leukoencephalopathy and relapsing-remitting multiple sclerosis: A comparative study', Archives of Neurology, vol. 66, no. 5, pp. 593-599. https://doi.org/10.1001/archneurol.2009.31
Boster, Aaron ; Hreha, Stephanie ; Berger, Joseph R. ; Bao, Fen ; Penmesta, Ramya ; Tselis, Alexandros ; Endress, Christina ; Zak, Imad ; Perumal, Jai ; Caon, Christina ; Vazquez, Jose Antonio ; Tyler, Kenneth L. ; Racke, Michael K. ; Millis, Scott ; Khan, Omar. / Progressive multifocal leukoencephalopathy and relapsing-remitting multiple sclerosis : A comparative study. In: Archives of Neurology. 2009 ; Vol. 66, No. 5. pp. 593-599.
@article{3f9150a4805341e9ab8448ccf709528f,
title = "Progressive multifocal leukoencephalopathy and relapsing-remitting multiple sclerosis: A comparative study",
abstract = "Objective: To identify clinical and magnetic resonance imaging (MRI) features that distinguish progressive multifocal leukoencephalopathy (PML) from relapsing-remitting multiple sclerosis (RRMS). Design: Retrospective medical record review. Setting: Two urban teaching hospitals in Detroit, Michigan. Patients: Forty-five confirmed PML cases and 100 patients with RRMS. Main Outcome Measures: Clinical and MRI features distinguishing PML from RRMS. Results: Overall, monosymptomatic presentations were more common in multiple sclerosis (MS) than PML (85{\%} vs 47{\%}; P<.01). However, patients with PML presented more often with hemiparesis (24{\%} vs 5{\%}; P=.001) and altered mentation (19{\%} vs 0{\%}; P<.0001), whereas brainstem (2{\%} vs 18{\%}; P=.007) presentations were more common in patients with RRMS. Spinal cord and optic neuritis presentations were seen in 18{\%} and 33{\%} of patients patients with RRMS, respectively, but not in patients with PML (P<.0001). Brain MRI scans, available in 35 (78{\%}) PML cases, revealed 7 lesion types. Large, confluent T2-weighted lesions (74{\%} vs 2{\%}; P<.0001) and deep gray matter lesions (31{\%} vs 7{\%}; P<.001) were more frequent in patients with PML than patients with RRMS. Crescentic cerebellar lesions (23{\%} vs 0{\%}; P<.001) were seen only in patients with PML. Gadolinium-enhancing (23{\%}), transcallosal (9{\%}), and periventricular (9{\%}) lesions were noted in patients with PML. Brain magnetization transfer ratio (MTR) was low in both PML and MS lesions. However, normal-appearing brain tissue MTR in PML was higher than normal-appearing brain tissue MTR in RRMS (44.15{\%} vs 41.04{\%}; P=.002), suggesting that PML may be relatively more focal than MS. Conclusions: There appear to be differences between the clinical and MRI characteristics of PML and RRMS, which may help distinguish new MS activity from PML. Magnetization transfer ratio studies may provide additional clues in improving early detection of PML in patients with preexisting MS and warrant further investigation.",
author = "Aaron Boster and Stephanie Hreha and Berger, {Joseph R.} and Fen Bao and Ramya Penmesta and Alexandros Tselis and Christina Endress and Imad Zak and Jai Perumal and Christina Caon and Vazquez, {Jose Antonio} and Tyler, {Kenneth L.} and Racke, {Michael K.} and Scott Millis and Omar Khan",
year = "2009",
month = "5",
day = "1",
doi = "10.1001/archneurol.2009.31",
language = "English (US)",
volume = "66",
pages = "593--599",
journal = "Archives of Neurology",
issn = "0003-9942",
publisher = "American Medical Association",
number = "5",

}

TY - JOUR

T1 - Progressive multifocal leukoencephalopathy and relapsing-remitting multiple sclerosis

T2 - A comparative study

AU - Boster, Aaron

AU - Hreha, Stephanie

AU - Berger, Joseph R.

AU - Bao, Fen

AU - Penmesta, Ramya

AU - Tselis, Alexandros

AU - Endress, Christina

AU - Zak, Imad

AU - Perumal, Jai

AU - Caon, Christina

AU - Vazquez, Jose Antonio

AU - Tyler, Kenneth L.

AU - Racke, Michael K.

AU - Millis, Scott

AU - Khan, Omar

PY - 2009/5/1

Y1 - 2009/5/1

N2 - Objective: To identify clinical and magnetic resonance imaging (MRI) features that distinguish progressive multifocal leukoencephalopathy (PML) from relapsing-remitting multiple sclerosis (RRMS). Design: Retrospective medical record review. Setting: Two urban teaching hospitals in Detroit, Michigan. Patients: Forty-five confirmed PML cases and 100 patients with RRMS. Main Outcome Measures: Clinical and MRI features distinguishing PML from RRMS. Results: Overall, monosymptomatic presentations were more common in multiple sclerosis (MS) than PML (85% vs 47%; P<.01). However, patients with PML presented more often with hemiparesis (24% vs 5%; P=.001) and altered mentation (19% vs 0%; P<.0001), whereas brainstem (2% vs 18%; P=.007) presentations were more common in patients with RRMS. Spinal cord and optic neuritis presentations were seen in 18% and 33% of patients patients with RRMS, respectively, but not in patients with PML (P<.0001). Brain MRI scans, available in 35 (78%) PML cases, revealed 7 lesion types. Large, confluent T2-weighted lesions (74% vs 2%; P<.0001) and deep gray matter lesions (31% vs 7%; P<.001) were more frequent in patients with PML than patients with RRMS. Crescentic cerebellar lesions (23% vs 0%; P<.001) were seen only in patients with PML. Gadolinium-enhancing (23%), transcallosal (9%), and periventricular (9%) lesions were noted in patients with PML. Brain magnetization transfer ratio (MTR) was low in both PML and MS lesions. However, normal-appearing brain tissue MTR in PML was higher than normal-appearing brain tissue MTR in RRMS (44.15% vs 41.04%; P=.002), suggesting that PML may be relatively more focal than MS. Conclusions: There appear to be differences between the clinical and MRI characteristics of PML and RRMS, which may help distinguish new MS activity from PML. Magnetization transfer ratio studies may provide additional clues in improving early detection of PML in patients with preexisting MS and warrant further investigation.

AB - Objective: To identify clinical and magnetic resonance imaging (MRI) features that distinguish progressive multifocal leukoencephalopathy (PML) from relapsing-remitting multiple sclerosis (RRMS). Design: Retrospective medical record review. Setting: Two urban teaching hospitals in Detroit, Michigan. Patients: Forty-five confirmed PML cases and 100 patients with RRMS. Main Outcome Measures: Clinical and MRI features distinguishing PML from RRMS. Results: Overall, monosymptomatic presentations were more common in multiple sclerosis (MS) than PML (85% vs 47%; P<.01). However, patients with PML presented more often with hemiparesis (24% vs 5%; P=.001) and altered mentation (19% vs 0%; P<.0001), whereas brainstem (2% vs 18%; P=.007) presentations were more common in patients with RRMS. Spinal cord and optic neuritis presentations were seen in 18% and 33% of patients patients with RRMS, respectively, but not in patients with PML (P<.0001). Brain MRI scans, available in 35 (78%) PML cases, revealed 7 lesion types. Large, confluent T2-weighted lesions (74% vs 2%; P<.0001) and deep gray matter lesions (31% vs 7%; P<.001) were more frequent in patients with PML than patients with RRMS. Crescentic cerebellar lesions (23% vs 0%; P<.001) were seen only in patients with PML. Gadolinium-enhancing (23%), transcallosal (9%), and periventricular (9%) lesions were noted in patients with PML. Brain magnetization transfer ratio (MTR) was low in both PML and MS lesions. However, normal-appearing brain tissue MTR in PML was higher than normal-appearing brain tissue MTR in RRMS (44.15% vs 41.04%; P=.002), suggesting that PML may be relatively more focal than MS. Conclusions: There appear to be differences between the clinical and MRI characteristics of PML and RRMS, which may help distinguish new MS activity from PML. Magnetization transfer ratio studies may provide additional clues in improving early detection of PML in patients with preexisting MS and warrant further investigation.

UR - http://www.scopus.com/inward/record.url?scp=66249118663&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=66249118663&partnerID=8YFLogxK

U2 - 10.1001/archneurol.2009.31

DO - 10.1001/archneurol.2009.31

M3 - Article

VL - 66

SP - 593

EP - 599

JO - Archives of Neurology

JF - Archives of Neurology

SN - 0003-9942

IS - 5

ER -