Progressive multifocal leukoencephalopathy: analysis of lesion development with diffusion-weighted MRI

Abstract

Progressive multifocal leukoencephalopathy (PML), caused by replication of JC virus in oligodendrocytes of immunocompromised patients, is diagnosed by polymerase chain reaction-based demonstration of JC virus DNA. We investigated whether MRI might be used to assess disease activity. Diffusion-weighted imaging (DWI) was obtained in two patients with PML, in whom it was the only MRI sequence on which we could identify areas of progressive disease. The extent of abnormal diffusion appeared to correlate with the speed of clinical progression. DWI would thus seem to be of value in patients with PML.

Progressive multifocal leukoencephalopathy in rheumatic diseases: Evolving clinical and pathologic patterns of disease

“…Diffusion-weighted MR images show areas of restricted diffusion associated with rapid progression of PML; resolution of the diffusion abnormality is observed in PML survivors, as has been described in case reports (78)(79)(80)(81). Single-photon-emission computed tomography imaging using thallium-201 as the tracer in patients with PML has been reported, but the results were inconsistent (82,83).…”

Use of Diffusion-Weighted Imaging to Evaluate the Initial Response of Progressive Multifocal Leukoencephalopathy to Highly Active Antiretroviral Therapy: Early Experience

“…Therefore, an elevated ADC at the center of slowly progressing lesions is associated with the loss of spatial organization and an increase in extracellular space, while reduced ADC at the lesion periphery is associated with cytotoxic edema and oligodendrocyte swelling in areas of active expansion. 13 ADC changes, therefore, appear to correspond with the pathologic features of PML.…”

“…In particular, PML lesions demonstrate patchy restricted diffusion at their periphery correlating with areas of lesion expansion. [12][13][14][15] High central ADC may reflect the evolution of PML lesions, indicating both how long they have existed and how likely they are to expand, 16 and ADC/DWI changes are thought to correlate directly with the pathophysiology of the disease. 13 Furthermore, initial studies of PML lesions following HAART therapy suggest that ADC/ DWI may correlate with treatment outcomes.…”

“…[12][13][14][15] High central ADC may reflect the evolution of PML lesions, indicating both how long they have existed and how likely they are to expand, 16 and ADC/DWI changes are thought to correlate directly with the pathophysiology of the disease. 13 Furthermore, initial studies of PML lesions following HAART therapy suggest that ADC/ DWI may correlate with treatment outcomes. 14 The purpose of our study was to determine whether ADC/ DWI measurements of PML lesions before and after initiation of HAART can be used to follow treatment response, in particular, the development of IRIS.…”

Polyomavirus JC-targeted T-cell therapy for progressive multiple leukoencephalopathy in a hematopoietic cell transplantation recipient

“…Magnetic resonance imaging (MRI) showed bilateral, multiple occipito-temporo-parietal subcortical lesions and hyperintense signal in the right thalamus ( Figure 1a). 17 Electroencephalogram showed diffuse electrical slowing, mostly involving frontal and temporo-occipital areas of the right hemisphere, without focal epileptic activity. The neuropsychological assessment documented severe global impairment of cognitive functions (Mini-Mental State corrected for age and school level, 14.6 of 23.8) (Figure 2).…”