7T MRI in natalizumab-associated PML and ongoing MS disease activity: a case study


  • T. Sinnecker
  • J. Othman
  • M. Kühl
  • R. Mekle
  • I. Selbig
  • T. Niendorf
  • A. Kunkel
  • P. Wienecke
  • P. Kern
  • F. Paul
  • J. Faiss
  • J. Wuerfel


  • Neurology Neuroimmunology & Neuroinflammation


  • Neurol Neuroimmunol Neuroinflamm 2 (6): e171


  • OBJECTIVE: To assess the ability of ultra-high-field MRI to distinguish early progressive multifocal leukoencephalopathy (PML) from multiple sclerosis (MS) lesions in a rare case of simultaneous presentation of natalizumab-associated PML and ongoing MS activity. METHODS: Advanced neuroimaging including 1.5T, 3T, and 7T MRI with a spatial resolution of up to 0.08 mm(3) was performed. RESULTS: 7T MRI differentiated between PML-related and MS-related brain damage in vivo. Ring-enhancing MS plaques displayed a central vein, whereas confluent PML lesions were preceded by punctate or milky way-like T2 lesions. CONCLUSIONS: Given the importance of early diagnosis of treatment-associated PML, future systematic studies are warranted to assess the value of highly resolving MRI in differentiating between early PML- and MS-induced brain parenchymal lesions.