• Neurology · Apr 2017

    Multicenter Study

    Leptomeningeal gadolinium enhancement across the spectrum of chronic neuroinflammatory diseases.

    • Martina Absinta, Irene C M Cortese, Luisa Vuolo, Govind Nair, Manori P de Alwis, Joan Ohayon, Alessandro Meani, Vittorio Martinelli, Roberta Scotti, Andrea Falini, Bryan R Smith, Avindra Nath, Steven Jacob... more son, Massimo Filippi, and Daniel S Reich. less
    • From the Division of Neuroimmunology and Neurovirology (M.A., I.C.M.C., L.V., G.N., M.P.d.A., J.O., B.R.S., A.N., S.J., D.S.R.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; ... more and the Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience (M.A., A.M., M.F.), Department of Neurology (V.M.), and Department of Neuroradiology (R.S., A.F.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy. martina.absinta@nih.gov daniel.reich@nih.gov. less
    • Neurology. 2017 Apr 11; 88 (15): 1439-1444.

    ObjectiveTo assess the prevalence and the specificity of leptomeningeal enhancement (LME) on postcontrast T2-fluid-attenuated inversion recovery (FLAIR) MRI in multiple sclerosis (MS) compared to a variety of inflammatory and noninflammatory neurologic conditions assessed in 2 academic research hospitals.MethodsOn 3T postcontrast T2-FLAIR images, the presence of focal gadolinium enhancement was evaluated in the leptomeningeal compartment in 254 people with non-MS neurologic conditions or neurotropic viral infections. Based on their clinical diagnosis, patients were grouped as follows: (1) other-than-MS inflammatory neurologic diseases; (2) noninflammatory neurologic diseases; (3) human T-lymphotropic virus (HTLV)-infected; (4) HIV-infected; (5) healthy volunteers.ResultsLME was detected in 56/254 non-MS cases (22%) vs 74/299 (25%) of MS cases. LME was nearly 4-fold more frequent in non-MS inflammatory neurologic conditions (18/51 cases, 35%) than in noninflammatory neurologic conditions (3/38, 8%) and healthy volunteers (5/66, 8%). The highest prevalence of LME was detected in HTLV infection (17/38 cases, 45%), particularly in the setting of HTLV-associated myelopathy (14/25 cases, 56%). LME also frequently occurred in HIV infection (13/61 cases, 21%). Unlike in MS, LME is not associated with lower brain and cortical volumes in non-MS inflammatory neurologic conditions, including HTLV and HIV infection.ConclusionsDespite its relevance to MS pathogenesis and cortical pathology, LME is not specific to MS, occurring frequently in non-MS inflammatory neurologic conditions and especially in those patients with HTLV-associated myelopathy. Overall, this strengthens the notion that LME localizes inflammation-related focal disruption of the blood-meninges barrier and associated scarring.© 2017 American Academy of Neurology.

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