Cortical hypointensity in T2-weighted gradient-echo sequences in patients with progressive multifocal leukoencephalopathy
| Autor: | P. López Sala, T. Cabada Giadás, N. Alberdi Aldasoro, M.C. Bacaicoa Saralegui, M.V. Zelaya Huerta |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Pathology
medicine.medical_specialty medicine.diagnostic_test business.industry Multiple sclerosis Progressive multifocal leukoencephalopathy Encephalopathy JC virus Magnetic resonance imaging medicine.disease_cause medicine.disease 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Natalizumab medicine Demyelinating disease General Earth and Planetary Sciences Rituximab business 030217 neurology & neurosurgery General Environmental Science medicine.drug |
| Zdroj: | Radiología (English Edition). 62:59-66 |
| ISSN: | 2173-5107 |
| Popis: | Introduction 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. Objective 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. Material and methods 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. Results 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. Conclusion 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. |
| Databáze: | OpenAIRE |
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