Friday, 20 November 2015

Distingusihing PML lesions from MS.

Sinnecker T, Othman J, Kühl M, Mekle R, Selbig I, Niendorf T, Kunkel A, Wienecke P, Kern P, Paul F, Faiss J, Wuerfel J. 7T MRI in natalizumab-associated PML and ongoing MS disease activity: A case study. Neurol Neuroimmunol Neuroinflamm. 2015; 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.

So this study looks at 7T MRI which has a resolution og 0.08mm3 so that is about 450micrometers  in any one plane 0.44 (0,44 x 0,44 x 0,44 = 0.085mm3, which is about 10-11 cells in either plane so resolution of about 1000 cells and MS lesions have a central vein compared to PML. Maybe a use for T2* imaging

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