title: The diagnostic role of diffusion tensor imaging in multifocal inflammatory leukoencephalopathy.
abstract: Multifocal inflammatory leukoencephalopathy (MIL) is a rare syndrome that can occur in patients with colon cancer after chemotherapy with 5-fluorouracil (5-FU) and levamisole. Histologic diagnosis by brain biopsy is most effective, but there can be high surgical risks and technical limitations. Therefore, we introduce a noninvasive diagnostic technique using diffusion tensor imaging (DTI) for patients suspected to have MIL. A 45-year-old woman had been treated for 12 weeks with levamisole and 5-FU for adenocarcinoma of the cecum, when she complained of ataxia, diplopia and left ptosis. Brain MRI showed a nodular enhancing lesion in the left midbrain, using gadolinium enhanced T1-weighted imaging, and scattered multiple white matter lesions throughout the cerebral hemisphere. Instead of a brain biopsy, DTI was performed that revealed reduced fractional anisotropy (FA) and increased radial diffusivity (RD) in the left midbrain lesion compared with the right midbrain denoting demyelination. Levamisole and 5-FU were discontinued, and she received intravenously 1 g of methylprednisolone daily for 5 d. After five weeks, follow-up DTI showed an increased FA and decreased RD, signifying the reversibility. DTI therefore may provide valuable information on diagnosing MIL and assessing the treatment response.
authors.affiliation: 1Department of Neurology and Radiology, Kyungpook National University Hospital, Daegu, Republic of Korea.
authors.forename: Yong-Won
authors.initials: YW
authors.lastname: Kim
authors.forename: Yang-Ha
authors.initials: YH
authors.lastname: Hwang
authors.forename: Dong-Hun
authors.initials: DH
authors.lastname: Kang
authors.forename: Sung-Pa
authors.initials: SP
authors.lastname: Park
authors.forename: Hyun-Seok
authors.initials: HS
authors.lastname: Song
authors.forename: Joo-Hyun
authors.initials: JH
authors.lastname: Kim
authors.forename: Yong-Sun
authors.initials: YS
authors.lastname: Kim
mesh_terms: D000963:Antimetabolites / Q000009:adverse effects; D000970:Antineoplastic Agents / Q000009:adverse effects; D001706:Biopsy; D001921:Brain / Q000473:pathology; D056324:Diffusion Tensor Imaging / Q000379:methods*; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D007968:Leukoencephalopathy, Progressive Multifocal / Q000139:chemically induced* / Q000175:diagnosis* / Q000473:pathology; D007978:Levamisole / Q000009:adverse effects; D008875:Middle Aged
chemical_list: D000963:Antimetabolites; D000970:Antineoplastic Agents; D007978:Levamisole; D005472:Fluorouracil