Neurology：FDG-PET成像有助于那他珠单抗治疗患者PML-IRIS和PML的鉴别

2018-10-17 zyx整理神经科病例撷英拾粹

57岁高度活动的复发缓解型多发性硬化（MS）女性患者，那他珠单抗治疗后出现构音障碍和右侧偏瘫。MRI可见T2高信号（图A）。脑脊液JC病毒DNA滴度> 1.1M，诊断为进行性多灶性白质脑病（PML）。予停用那他珠单抗。

57岁高度活动的复发缓解型多发性硬化（MS）女性患者，那他珠单抗治疗后出现构音障碍和右侧偏瘫。MRI可见T2高信号（图A）。脑脊液JC病毒DNA滴度> 1.1M，诊断为进行性多灶性白质脑病（PML）。予停用那他珠单抗。

四周后，尽管JC病毒滴度下降，仍然出现球麻痹和左侧偏瘫。复查MRI提示PML恶化或PML免疫重建炎症综合征（IRIS）可能（图B和C）。FDG-PET证实PML初始部位相对低代谢，左侧脑桥和小脑中脚高代谢（图D），提示PML-IRIS。开始使用泼尼松龙，后续病情稳定。

早期予以类固醇激素治疗对PML-IRIS的炎症控制至关重要；但其使用可能使得JC病毒清除率减低，随后出现PML进展。在MRI上区分PML，PML-IRIS和新的活动性MS具有挑战性。因此，在存在疑问的情况下，FDG-PET可以提供有用信息，以指导在这种复杂的临床环境中的治疗决策。

（图：A：T2WI可见右侧齿状核周和小脑中脚[MCP]高信号，符合进行性多灶性白质脑病[PML]。B-C：复查影像学可见小脑和脑干T2高信号伴强化；D：FDG-PET可见PML初始部位右侧小脑低代谢[黑箭]，脑桥和左侧MCP高代谢[白箭]，符合PML-免疫重建炎症综合征）

原始出处：Baheerathan A1, McNamara C2, Kalam S2, et al. The utility of FDG-PET imaging in distinguishing PML-IRIS from PML in a patient treated with natalizumab. Neurology. 2018 Sep 18;91(12):572-573.

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2018-12-15 feather89

#PE#

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2018-10-19 yinhl1978

#Neurol#

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2018-11-09 ms1260584454294838

#PET成像#

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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/08/29/bbc5cc0eed9b8d17623d2fd49dbdf19a.jpg, createdBy=79522135794, createdName=yjs木玉, createdTime=Wed Oct 17 05:23:37 CST 2018, time=2018-10-17, status=1, ipAttribution=)]
2019-09-24 ms9474365431325850

#那他珠单抗#

30 0
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2018-10-18 ms7514935887898259

#PET#

31 0
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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/08/29/bbc5cc0eed9b8d17623d2fd49dbdf19a.jpg, createdBy=79522135794, createdName=yjs木玉, createdTime=Wed Oct 17 05:23:37 CST 2018, time=2018-10-17, status=1, ipAttribution=)]
2018-10-18 yinhl1985

#PML#

24 0
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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/08/29/bbc5cc0eed9b8d17623d2fd49dbdf19a.jpg, createdBy=79522135794, createdName=yjs木玉, createdTime=Wed Oct 17 05:23:37 CST 2018, time=2018-10-17, status=1, ipAttribution=)]
2018-10-17 183****7028

学习

58 0
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createdBy=8217292, createdName=yinhl1978, createdTime=Fri Oct 19 06:14:00 CST 2018, time=2018-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2039486, encodeId=8cf2203948665, content=<a href='/topic/show?id=cfbf14091d5' target=_blank style='color:#2F92EE;'>#PET成像#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14091, encryptionId=cfbf14091d5, topicName=PET成像)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdqq.qlogo.cn/qqapp/1103841572/D2FD7704B41C9E22364B1E54ABB223BB/100, createdBy=1df22500220, createdName=ms1260584454294838, createdTime=Fri Nov 09 00:14:00 CST 2018, time=2018-11-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1689098, encodeId=7bff1689098d7, content=<a href='/topic/show?id=7e88952e86f' target=_blank style='color:#2F92EE;'>#那他珠单抗#</a>, beContent=null, objectType=article, channel=null, 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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/08/29/bbc5cc0eed9b8d17623d2fd49dbdf19a.jpg, createdBy=79522135794, createdName=yjs木玉, createdTime=Wed Oct 17 05:23:37 CST 2018, time=2018-10-17, status=1, ipAttribution=)]
2018-10-17 明月清辉

谢谢分享，学习了

50 0
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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/08/29/bbc5cc0eed9b8d17623d2fd49dbdf19a.jpg, createdBy=79522135794, createdName=yjs木玉, createdTime=Wed Oct 17 05:23:37 CST 2018, time=2018-10-17, status=1, ipAttribution=)]
2018-10-17 yjs木玉

好好好好好好好好

51 0

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