title: Leptomeningeal gadolinium enhancement across the spectrum of chronic neuroinflammatory diseases.
abstract: OBJECTIVE
  To 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.
  
  
  METHODS
  On 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.
  
  
  RESULTS
  LME 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.
  
  
  CONCLUSIONS
  Despite 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.
authors.affiliation: 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; 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.
authors.forename: Martina
authors.initials: M
authors.lastname: Absinta
authors.affiliation: 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; 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.
authors.forename: Irene C M
authors.initials: IC
authors.lastname: Cortese
authors.affiliation: 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; 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.
authors.forename: Luisa
authors.initials: L
authors.lastname: Vuolo
authors.affiliation: 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; 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.
authors.forename: Govind
authors.initials: G
authors.lastname: Nair
authors.affiliation: 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; 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.
authors.forename: Manori P
authors.initials: MP
authors.lastname: de Alwis
authors.affiliation: 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; 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.
authors.forename: Joan
authors.initials: J
authors.lastname: Ohayon
authors.affiliation: 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; 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.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Meani
authors.affiliation: 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; 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.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Martinelli
authors.affiliation: 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; 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.
authors.forename: Roberta
authors.initials: R
authors.lastname: Scotti
authors.affiliation: 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; 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.
authors.forename: Andrea
authors.initials: A
authors.lastname: Falini
authors.affiliation: 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; 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.
authors.forename: Bryan R
authors.initials: BR
authors.lastname: Smith
authors.affiliation: 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; 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.
authors.forename: Avindra
authors.initials: A
authors.lastname: Nath
authors.affiliation: 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; 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.
authors.forename: Steven
authors.initials: S
authors.lastname: Jacobson
authors.affiliation: 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; 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.
authors.forename: Massimo
authors.initials: M
authors.lastname: Filippi
authors.affiliation: 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; 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.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Reich
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004660:Encephalitis / Q000134:cerebrospinal fluid / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D005682:Gadolinium / Q000378:metabolism*; D015658:HIV Infections / Q000134:cerebrospinal fluid / Q000000981:diagnostic imaging; D006801:Humans; D021621:Imaging, Three-Dimensional; D007958:Leukocyte Count; D016014:Linear Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008578:Meninges / Q000000981:diagnostic imaging*; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000134:cerebrospinal fluid / Q000000981:diagnostic imaging; D009422:Nervous System Diseases / Q000134:cerebrospinal fluid / Q000000981:diagnostic imaging; D043025:Oligoclonal Bands / Q000134:cerebrospinal fluid; D055815:Young Adult
chemical_list: D043025:Oligoclonal Bands; D005682:Gadolinium