TY - JOUR
T1 - Metabolic profile of PML lesions in patients with and without IRIS an observational study
AU - Gheuens, Sarah
AU - Ngo, Long
AU - Wang, Xiaoen
AU - Alsop, David C.
AU - Lenkinski, Robert E.
AU - Koralnik, Igor J.
N1 - Funding Information:
S. Gheuens is funded by NIH grant T32-AI07387-21 and is a fellow of the Clinical Investigator Training Program: Beth Israel Deaconess Medical Center–Harvard/MIT Health Sciences and Technology, in collaboration with Pfizer Inc. and Merck & Co. L. Ngo reports no disclosures. X. Wang is supported in part by NIH grant R01-NS047029 . D. Alsop is an inventor on several patents related to perfusion MRI (US patents 7,545,142, 7,369,888, 6,980,845, and 6,717,405), for which he has received royalties from GE Healthcare and Siemens Medical; receives research support from GE Healthcare and is also supported by grants from the NIH (CA115745, EB004582, MH80729, MH077073, DC008796, NS047029, CA101942, AG031720, AG028076, and DK084463) and the Congressionally Directed Military Research Program of the Department of Defense (SC090251); and serves as Associate Editor of Magnetic Resonance in Medicine. R. Lenkinski is supported in part by NIH grant R01-NS047029 and receives research support from GE Healthcare. I. Koralnik is funded by NIH grants R56-NS041198, R01-NS047029, and K24-NS060950 ; has received a research grant from Biogen Idec and the National Multiple Sclerosis Society; served on scientific advisory boards for Hoffmann La-Roche, GlaxoSmithKline, and Merck Serono; received consulting fees from Bristol-Myers Squibb, Ono Pharmaceuticals, Merck Serono, Hoffmann La Roche, GlaxoSmithKline, Perseid Therapeutics, Vertex Pharmaceutical, and Johnson & Johnson; is an editorial board member for the Journal of NeuroVirology; and receives royalties from UpToDate for topics on the management of HIV and CNS mass lesions and on PML. Go to Neurology.org for full disclosures.
PY - 2012/9/4
Y1 - 2012/9/4
N2 - Objective: To characterize progressive multifocal leukoencephalopathy (PML) lesions by contrastenhanced MRI and evaluate their metabolism using proton magnetic resonance spectroscopy (1H-MRS) in the setting of immune reconstitution inflammatory syndrome (IRIS). Methods: A total of 42 patients with PML underwent a clinical evaluation as well as brain MRI and 1H-MRS at baseline and 3, 6, and 12 months later. The presence of IRIS was determined based on clinical and laboratory criteria. Ratios of N-acetylaspartate (NAA), choline (Cho), myo-inositol (mI), and lipid/lactate (Lip1 and Lip2) to creatine (Cr) were measured and correlated with the presence of contrast enhancement (CE) in PML lesions. Results: IRIS occurred in 16 of 28 (57.1%) PML survivors (PML-S) and 1 of 14 (7.1%) PML progressors (PML-P). Lesions of patients with PML-IRIS showed significantly higher Cho/Cr (p = 0.0001), mI/Cr (p = 0.02), Lip1/Cr (p < 0.0001), and Lip2/Cr (p = 0.002) ratios and lower NAA/Cr (p = 0.02) ratios than patients with PML who did not have IRIS. An elevated Cho/Cr ratio was associated with CE within the 1H-MRS voxel, whereas lipid/Cr ratios were elevated in PML-IRIS lesions independently of CE. Follow-up until 33 months from PML onset showed persistent elevation of the mI/Cr ratio in lesions of patients with PML-IRIS. A Lip1/Cr ratio greater than 1.5 combined with the presence of CE yielded a 79% probability of IRIS compared with 13% in the absence of these criteria. Conclusion: 1H-MRS is a valuable tool to recognize and track IRIS in PML and may prove useful in the clinical management of these patients.
AB - Objective: To characterize progressive multifocal leukoencephalopathy (PML) lesions by contrastenhanced MRI and evaluate their metabolism using proton magnetic resonance spectroscopy (1H-MRS) in the setting of immune reconstitution inflammatory syndrome (IRIS). Methods: A total of 42 patients with PML underwent a clinical evaluation as well as brain MRI and 1H-MRS at baseline and 3, 6, and 12 months later. The presence of IRIS was determined based on clinical and laboratory criteria. Ratios of N-acetylaspartate (NAA), choline (Cho), myo-inositol (mI), and lipid/lactate (Lip1 and Lip2) to creatine (Cr) were measured and correlated with the presence of contrast enhancement (CE) in PML lesions. Results: IRIS occurred in 16 of 28 (57.1%) PML survivors (PML-S) and 1 of 14 (7.1%) PML progressors (PML-P). Lesions of patients with PML-IRIS showed significantly higher Cho/Cr (p = 0.0001), mI/Cr (p = 0.02), Lip1/Cr (p < 0.0001), and Lip2/Cr (p = 0.002) ratios and lower NAA/Cr (p = 0.02) ratios than patients with PML who did not have IRIS. An elevated Cho/Cr ratio was associated with CE within the 1H-MRS voxel, whereas lipid/Cr ratios were elevated in PML-IRIS lesions independently of CE. Follow-up until 33 months from PML onset showed persistent elevation of the mI/Cr ratio in lesions of patients with PML-IRIS. A Lip1/Cr ratio greater than 1.5 combined with the presence of CE yielded a 79% probability of IRIS compared with 13% in the absence of these criteria. Conclusion: 1H-MRS is a valuable tool to recognize and track IRIS in PML and may prove useful in the clinical management of these patients.
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U2 - 10.1212/WNL.0b013e318268465b
DO - 10.1212/WNL.0b013e318268465b
M3 - Article
C2 - 22914832
AN - SCOPUS:84866118855
SN - 0028-3878
VL - 79
SP - 1041
EP - 1048
JO - Neurology
JF - Neurology
IS - 10
ER -