Radiological abnormalities in progressive multifocal leukoencephalopathy: Identifying typical and atypical imaging patterns for early diagnosis and differential considerations

Mult Scler Relat Disord. 2023 Sep:77:104830. doi: 10.1016/j.msard.2023.104830. Epub 2023 Jun 24.

Abstract

Progressive multifocal leukoencephalopathy (PML) is a rare viral central nervous system (CNS) demyelinating disease primarily associated with a compromised immune system. PML is seen mainly in individuals with human immunodeficiency virus, lymphoproliferative disease, and multiple sclerosis. Patients on immunomodulators, chemotherapy, and solid organ or bone marrow transplants are predisposed to PML. Recognition of various PML-associated typical and atypical imaging abnormalities is critical for early diagnosis and differentiating it from other conditions, especially in high-risk populations. Early PML recognition should expedite efforts at immune-system restoration, allowing for a favorable outcome. This review aims to provide a practical overview of radiological abnormalities in PML patients and address differential considerations.

Keywords: John Cunningham virus (JCV); Natalizumab (NTZ); PML immune reconstitution inflammatory syndrome (IRIS); Progressive multifocal leukoencephalopathy (PML).

Publication types

  • Review

MeSH terms

  • Early Diagnosis
  • Humans
  • Immune Reconstitution Inflammatory Syndrome*
  • JC Virus*
  • Leukoencephalopathy, Progressive Multifocal* / diagnostic imaging
  • Multiple Sclerosis* / drug therapy
  • Natalizumab / therapeutic use

Substances

  • Natalizumab