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MRI Contributes to the Differentiation Between MS and HTLV-I Associated Myelopathy in British Columbian Coastal Natives

Published online by Cambridge University Press:  02 December 2014

Andrew K. Howard ,
David K.B. Li  and
Joël Oger
Andrew K. Howard
Affiliation:
Multiple Sclerosis Clinic, Department of Medicine, and Department of Radiology; Faculty of Medicine, University of British Columbia and UBC Hospital;, Vancouver, British Columbia, Canada
David K.B. Li
Affiliation:
Multiple Sclerosis Clinic, Department of Medicine, and Department of Radiology; Faculty of Medicine, University of British Columbia and UBC Hospital;, Vancouver, British Columbia, Canada
Joël Oger
Affiliation:
Multiple Sclerosis Clinic, Department of Medicine, and Department of Radiology; Faculty of Medicine, University of British Columbia and UBC Hospital;, Vancouver, British Columbia, Canada
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Abstract

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Background:

Human T-cell lymphotropic virus type I (HTLV-I)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) in British Columbian Coastal Natives has, to date, been a clinical and laboratory diagnosis. However, magnetic resonance imaging (MRI) abnormalities have been well-described in other populations in which HAM/TSP is endemic.

Methods:

In order to assess the usefulness of MRI as a diagnostic tool in this population, we compared scans of HAM/TSP patients with those of HTLV-I positive non-HAM/TSP British Columbian Coastal Natives (carriers) and multiple sclerosis patients presenting with progressive paraparesis.

Results:

The typical nonspecific findings of thoracic cord atrophy and increased signal in the periventricular and subcortical white matter on T2-weighted images were confirmed in the HAM/TSP patients. Despite a lack of specificity of the MRI findings between HAM/TSP patients and HTLV-I carriers, criteria that could effectively differentiate HAM/TSP patients from multiple sclerosis patients with similar clinical presentations were determined.

Conclusions:

Clinical and radiological correlations suggest that longitudinal MRI investigations charting the course of HAM/TSP may reveal the clinical significance of these lesions and further define the role of MRI in the diagnosis of this entity. Magnetic resonance imaging is an important supplement to immunological and clinical data in differentiating multiple sclerosis from HAM/TSP.

Résumé:

RÉSUMÉ:Contexte:

La myélopathie associée au HTLV-1/paraparésie spastique tropicale (HAM/TSP) chez les autochtones de la région côtière de la Colombie Britannique était jusqu’à ce jour un diagnostic basé sur la clinique et le laboratoire. Cependant, les anomalies observées à l’imagerie par résonance magnétique (IRM) ont été bien décrites dans d’autres populations chez qui le HAM/TSP est endémique.

Méthodes:

Nous avons comparé les scans de patients atteints de HAM/TSP avec ceux de patients autochtones de la région côtière de la Colombie Britannique HTLV-1 positifs sans HAM/TSP et de patients atteints de sclérose en plaques (SEP) présentant une paraparésie progressive afin d’évaluer l’utilité de l’IRM comme outil diagnostique dans cette population.

Résultats:

L’atrophie de la moelle thoracique et l’augmentation du signal dans la substance blanche périventriculaire et sous-corticale sur les images pondérées en T2, qui sont des observations non spécifiques typiques, ont été confirmées chez les patients atteints de HAM/TSP. Malgré le manque de spécificité des observations à l’IRM entre les patients atteints de HAM/TSP et les porteurs de HTLV-1, des critères qui pourraient permettre de différentier les patients atteints de HAM/TSP des patients atteints de SEP présentant un tableau clinique similaire ont été établis.

Conclusions:

Des corrélations cliniques et radiologiques suggèrent que l’investigation longitudinale par IRM documentant l’évolution de la HAM/TSP peut révéler la signification clinique de ces lésions et aider à définir le rôle de l’IRM dans le diagnostic de cette maladie. L’IRM ajoute de l’information supplémentaire importante aux données immunologiques et cliniques pour distinguer la SEP de la HAM/TSP.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 30 , Issue 1 , February 2003 , pp. 41 - 48
Copyright
Copyright © The Canadian Journal of Neurological 2003

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