Journal Article

Progressive multifocal leukoencephalopathy: MRI findings in HIV-infected patients are closer to rituximab- than natalizumab-associated PML

Bourre, Bertrand, Vermersch, Patrick, Chauchet, Adrien, Solis, Morgane, Fafi-Kremer, Samira, Kerschen, Philippe, Bonneville, Fabrice, Chabrot, Cécile Moluçon, Martin-Blondel, Guillaume, Ahle, Guido, Claise, Béatrice, Maillart, Élisabeth, De Seze, Jérôme, Malak, Sandra, Bonnefoy, Jérôme Tamburini, Alleg, Manel, Papeix, Caroline, Leclerc, Xavier, Caulier, Alexis, Marolleau, Jean-Pierre, Cotton, François, Agape, Philippe, Roussel, Xavier, Kremer, Stéphane, Baloglu, Seyyid, Pruvo, Jean-Pierre, Kennel, Céline, Houillier, Caroline

2021

Overview

Objectives To compare brain MRI findings in progressive multifocal leukoencephalopathy (PML) associated to rituximab and natalizumab treatments and HIV infection. Materials and methods In this retrospective, multicentric study, we analyzed brain MRI exams from 72 patients diagnosed with definite PML: 32 after natalizumab treatment, 20 after rituximab treatment, and 20 HIV patients. We compared T2- or FLAIR-weighted images, diffusion-weighted images, T2*-weighted images, and contrast enhancement features, as well as lesion distribution, especially gray matter involvement. Results The three PML entities affect U-fibers associated with low signal intensities on T2*-weighted sequences. Natalizumab-associated PML showed a punctuate microcystic appearance in or in the vicinity of the main PML lesions, a potential involvement of the cortex, and contrast enhancement. HIV and rituximab-associated PML showed only mild contrast enhancement, punctuate appearance, and cortical involvement. The CD4/CD8 ratio showed a trend to be higher in the natalizumab group, possibly mirroring a more efficient immune response. Conclusion Imaging features of rituximab-associated PML are different from those of natalizumab-associated PML and are closer to those observed in HIV-associated PML. Key Points • Nowadays, PML is emerging as a complication of new effective therapies based on monoclonal antibodies. • Natalizumab-associated PML shows more inflammatory signs, a perivascular distribution “the milky way,” and more cortex involvement than rituximab- and HIV-associated PML. • MRI differences are probably related to higher levels of immunosuppression in HIV patients and those under rituximab therapy.

• Publisher: Springer Berlin Heidelberg,Springer Nature B.V,Springer Verlag
• Subject: Brain / Brain - diagnostic imaging / CD4 antigen / CD8 antigen / Diagnostic Radiology / Encephalitis / HIV / HIV Infections - complications / HIV Infections - drug therapy / Human health and pathology / Human immunodeficiency virus / Humans / Image contrast / Image enhancement / Imaging / Immune response / Immune system / Immunosuppression / Immunotherapy / Infectious diseases / Inflammation / Internal Medicine / Interventional Radiology / Lesions / Leukoencephalopathy / Leukoencephalopathy, Progressive Multifocal - chemically induced / Leukoencephalopathy, Progressive Multifocal - diagnostic imaging / Life Sciences / Magnetic Resonance Imaging / Medical imaging / Medicine / Medicine & Public Health / Monoclonal antibodies / Natalizumab - adverse effects / Neuro / Neuroimaging / Neuroradiology / Progressive multifocal leukoencephalopathy / Radiology / Retrospective Studies / Rituximab / Rituximab - adverse effects / Substantia grisea / Ultrasound / Viral infections