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Research ArticleAdult Brain

Susceptibility-Weighted MR Imaging Hypointense Rim in Progressive Multifocal Leukoencephalopathy: The End Point of Neuroinflammation and a Potential Outcome Predictor

M.M Thurnher, J. Boban, A. Rieger and E. Gelpi
American Journal of Neuroradiology June 2019, 40 (6) 994-1000; DOI: https://doi.org/10.3174/ajnr.A6072
M.M Thurnher
aFrom the Departments of Biomedical Imaging and Image-Guided Therapy (M.M.T., J.B.)
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J. Boban
aFrom the Departments of Biomedical Imaging and Image-Guided Therapy (M.M.T., J.B.)
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A. Rieger
bDermatology (A.R.)
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E. Gelpi
cInstitute of Neurology (E.G.), University Hospital Vienna, Medical University of Vienna, Vienna, Austria
dNeurological Tissue Bank of the Biobanc-Hospital Clinic-Institut dÌnvestigacions Biomediques August Pi i Sunyer (E.G.), Barcelona, Spain.
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    Fig 1.

    Kaplan-Meier survival analysis, with differences in survival and outcome between patients with (in purple) and without (in orange) an SWI-hypointense rim.

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    Fig 2.

    On axial FLAIR images (A–C), multifocal PML lesions are observed in both frontal lobes, the capsula interna and externa, and the right parietal lobe. A linear, relatively thin hypointense rim is observed on the cortical side of the lesions on axial SWI (D–F) in a long-term survivor (9 years, still alive).

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    Fig 3.

    A typical T2-weighted (A) and FLAIR (B) hyperintense PML lesion is observed in the frontoparietal corona radiata on the right side. On the postcontrast T1-weighted axial image (C), only a faint enhancement pattern is observed. On the axial SWI (D), there are no signs of a gyriform hypointense rim. The patient was classified as a short-term survivor (11 weeks).

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    Fig 4.

    On an axial FLAIR image (A), bilateral high-signal-intensity lesions are detected. DWI clearly demonstrates a high-signal-intensity rim at the periphery of the lesion in the right frontal lobe on trace DWI (B), with low ADC values (C) indicating restricted diffusion. On SWI (D), no abnormalities are seen. On follow-up MR imaging (3 months later), atrophic changes with dilation of the ventricles are observed in both hemispheres (more prominent in the right) (E). On DWI/ADC (F and G), no hyperintense rim is present. On SWI (H), a dark rim is clearly visible.

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American Journal of Neuroradiology: 40 (6)
American Journal of Neuroradiology
Vol. 40, Issue 6
1 Jun 2019
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M.M Thurnher, J. Boban, A. Rieger, E. Gelpi
Susceptibility-Weighted MR Imaging Hypointense Rim in Progressive Multifocal Leukoencephalopathy: The End Point of Neuroinflammation and a Potential Outcome Predictor
American Journal of Neuroradiology Jun 2019, 40 (6) 994-1000; DOI: 10.3174/ajnr.A6072

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Susceptibility-Weighted MR Imaging Hypointense Rim in Progressive Multifocal Leukoencephalopathy: The End Point of Neuroinflammation and a Potential Outcome Predictor
M.M Thurnher, J. Boban, A. Rieger, E. Gelpi
American Journal of Neuroradiology Jun 2019, 40 (6) 994-1000; DOI: 10.3174/ajnr.A6072
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