Imaging

Progressive Multifocal Leukoenceophalopathy

Preliminary Diagnosis: Progressive Multifocal Leukoenceophalopathy

I. What imaging technique is first-line for this diagnosis?

MR of the brain with contrast and special demyelinating protocol.

II. Describe the advantages and disadvantages of this technique for diagnosing progressive multifocal leukoenceophalopathy.

Advantages

  • Able to delineate subtle and more conspicuous confluent white matter abnormalities often affecting the subcortical white matter.

Disadvantages

  • Expensive.

  • Time consuming.

  • Requires significant patient cooperation to minimize motion artifact.

III. What are the contraindications for the first-line imaging technique?

Non-MR compatible hardware.

IV. What alternative imaging techniques are available?

CT imaging of the brain without contrast.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing progressive multifocal leukoenceophalopathy.

Advantages

  • Less expensive and much faster to perform than MR imaging.

Disadvantages

  • Less sensitive and specific in identifying, characterizing, and detailing any specific white matter abnormalities than MRI.

  • Exposes the patient to ionizing radiation.

VI. What are the contraindications for the alternative imaging techniques?

May be contraindicated in pregnant patients.

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