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
AU - Tyler, Kenneth L.
AU - Racke, Michael K.
AU - Millis, Scott
AU - Khan, Omar
N1 - Copyright:
Copyright 2009 Elsevier B.V., All rights reserved.
PY - 2009/5
Y1 - 2009/5
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.
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U2 - 10.1001/archneurol.2009.31
DO - 10.1001/archneurol.2009.31
M3 - Article
C2 - 19433659
AN - SCOPUS:66249118663
SN - 0003-9942
VL - 66
SP - 593
EP - 599
JO - Archives of Neurology
JF - Archives of Neurology
IS - 5
ER -