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Research ArticleClinical Investigations

Evidence of Brain Inflammation in Patients with Human T-Lymphotropic Virus Type 1–Associated Myelopathy (HAM): A Pilot, Multimodal Imaging Study Using 11C-PBR28 PET, MR T1-Weighted, and Diffusion-Weighted Imaging

Rahul Dimber, Qi Guo, Courtney Bishop, Adine Adonis, Aisling Buckley, Agnes Kocsis, David Owen, Nicola Kalk, Rexford Newbould, Roger N. Gunn, Eugenii A. Rabiner and Graham P. Taylor
Journal of Nuclear Medicine December 2016, 57 (12) 1905-1912; DOI: https://doi.org/10.2967/jnumed.116.175083
Rahul Dimber
1Imanova, Centre for Imaging Sciences, London, United Kingdom
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Qi Guo
2Institute of Psychiatry, King’s College London, London, United Kingdom
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Courtney Bishop
1Imanova, Centre for Imaging Sciences, London, United Kingdom
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Adine Adonis
3National Centre for Human Retrovirology, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
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Aisling Buckley
4Department of Clinical Health Psychology, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; and
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Agnes Kocsis
4Department of Clinical Health Psychology, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; and
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David Owen
5Division of Brain Sciences, Imperial College London, London, United Kingdom
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Nicola Kalk
5Division of Brain Sciences, Imperial College London, London, United Kingdom
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Rexford Newbould
1Imanova, Centre for Imaging Sciences, London, United Kingdom
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Roger N. Gunn
1Imanova, Centre for Imaging Sciences, London, United Kingdom
5Division of Brain Sciences, Imperial College London, London, United Kingdom
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Eugenii A. Rabiner
1Imanova, Centre for Imaging Sciences, London, United Kingdom
2Institute of Psychiatry, King’s College London, London, United Kingdom
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Graham P. Taylor
3National Centre for Human Retrovirology, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
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  • FIGURE 1.
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    FIGURE 1.

    Comparison of regional VT (left) and DVR (right) of 11C-PBR28 in HTLV1 subjects compared with healthy volunteers. Error bar is 1 SD. Amy = amygdala; Asym1 = patient 6, asymptomatic; Asym2 = patient 7, asymptomatic; Br.Stem = brain stem; Cau = caudate; Cereb = cerebellum; HAMs1 = patient 1, severe HAM; HAMs2 = patient 2, severe HAM; HAMmi = patient 4, mild HAM; HAMmo = patient 5, moderate HAM; Hip = hippocampus; mid = mid brain; Tha = thalamus.

  • FIGURE 2.
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    FIGURE 2.

    Spatially normalized VT parametric maps of individual HTLV-1 carriers and population-averaged healthy controls. Asym1 = patient 6, asymptomatic; Asym2 = patient 7, asymptomatic; Avg = average; HAMs1 = patient 1, severe HAM; HAMs2 = patient 2, severe HAM; HAMmi = patient 4, mild HAM; HAMmo = patient 5, moderate HAM.

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    FIGURE 3.

    Spearman rank correlation analysis of in vivo thalamus PET outcome measures in HTLV-1–infected subjects with laboratory and clinical assessments. Top (left to right): correlation between VT and 10-m walk time in log scale and CD8+DR+ cell counts. Bottom (left to right): correlation between DVR and 10-m walk time in log scale and CD8+DR+ cell counts. TW = timed walk.

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    FIGURE 4.

    VBM analysis: small clusters of altered GM topography in HTLV-1–infected patients compared with controls.

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    FIGURE 5.

    Regional GM fractions in HTLV-1 patients compared with healthy volunteers. Error bar is 1 SD.

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    FIGURE 6.

    Correlations of left thalamus GM fraction (top) and right thalamus MD (bottom) with (left to right) clinical (10-m timed walk) and laboratory (% circulating CD8+ lymphocytes expressing HLA-DR) scores.

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    TABLE 1

    Demographics, Neurology, HTLV-1 Virology, and Immunology

    Subject no. in analysisAge (y)SexEthnicityDuration disease (y)Mobility aid10-m TW (s)PETMRIDWIHTLV-1* proviral loadCD8 DRDisease
    #1 HAMs155FemaleCaucasian19Frame36655 min✓✓4.959Severe HAM progressing
    #2 HAMs248FemaleCaucasian5Frame109✓✓✓17.447Severe HAM progressing
    #3 HAMmo66FemaleAfro-Caribbean81 stick14.50 min✓x3.842Moderate HAM stable
    #4 HAMmi59FemaleAfro-Caribbean2Unaided11.5✓✓✓7.932Mild HAM stable
    #5 HAMmo54MaleAfro-Caribbean13Elbow crutches24.7✓✓✓10.532Moderate HAM slow progression
    #6 Asym157FemaleAfro-CaribbeanN/AUnaided6.5✓✓✓6.427Asymptomatic
    #7 Asym257MaleAfro-CaribbeanN/AUnaided6.6✓✓✓2.617Asymptomatic
    • ↵* HTLV-1 DNA copies per 100 PBMCs.

    • 10-m TW = time taken to walk 10 m on the flat; CD8 DR = % CD8 lymphocytes expressing human leukocyte antigen–antigen D related; HAMs1 = patient 1, severe HAM; HAMs2 = patient 2, severe HAM; HAMmo = patient 5, moderate HAM; HAMmi = patient 4, mild HAM; Asym1 = patient 6, asymptomatic; Asym 2 = patient 7, asymptomatic.

    • View popup
    TABLE 2

    PET Regional VT Data Analysis: z Scores of Individual Patient Regional VT Values Compared with Healthy Volunteers

    Subject codeHAMs1HAMs2HAMmoHAMmiAsym1Asym2
    Brain stem−0.301.942.11−0.06−0.19−1.30
    Medulla−0.331.882.270.25−0.28−0.68
    Pons−0.482.011.30−0.10−0.17−1.50
    Mid brain−0.051.382.98−0.20−0.25−1.24
    Thalamus0.602.452.71−0.47−0.16−1.93
    Hippocampus−0.551.671.76−0.33−0.19−1.34
    Amygdala−0.621.220.95−0.73−0.28−1.35
    Cerebellum−0.221.951.540.27−0.17−1.56
    Caudate−0.071.072.081.32−0.27−2.10
    Gray matter−0.161.291.080.12−0.13−1.61
    Brain−0.171.381.120.25−0.13−1.57
    • HAMs1 = patient 1, severe HAM; HAMs2 = patient 2, severe HAM; HAMmo = patient 5, moderate HAM; HAMmi = patient 4, mild HAM; Asym1 = patient 6, asymptomatic; Asym2 = patient 7, asymptomatic.

    • View popup
    TABLE 3

    PET Regional DVR Data Analysis: z Scores of Individual Patient Regional DVR Values Compared with Healthy Volunteers

    Subject codeHAMs1HAMs2HAMmoHAMmiAsym1Asym2
    Brain stem−0.403.084.23−0.29−0.99−0.11
    Medulla−0.292.032.920.52−0.370.78
    Pons−0.802.481.46−0.36−0.70−0.93
    Mid brain0.431.356.26−0.83−1.600.33
    Thalamus4.726.168.84−3.33−1.17−3.33
    Hippocampus−1.572.443.52−1.53−1.600.31
    Amygdala−1.490.940.77−2.42−2.30−0.31
    Cerebellum−0.273.352.790.79−1.660.17
    Caudate0.05−0.301.071.42−1.07−0.81
    Gray matter0.413.394.010.17−2.080.00
    Brain0.416.135.944.44−2.482.58
    • HAMs1 = patient 1, severe HAM; HAMs2 = patient 2, severe HAM; HAMmo = patient 5, moderate HAM; HAMmi = patient 4, mild HAM; Asym1 = patient 6, asymptomatic; Asym2 = patient 7, asymptomatic.

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Journal of Nuclear Medicine: 57 (12)
Journal of Nuclear Medicine
Vol. 57, Issue 12
December 1, 2016
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Evidence of Brain Inflammation in Patients with Human T-Lymphotropic Virus Type 1–Associated Myelopathy (HAM): A Pilot, Multimodal Imaging Study Using 11C-PBR28 PET, MR T1-Weighted, and Diffusion-Weighted Imaging
Rahul Dimber, Qi Guo, Courtney Bishop, Adine Adonis, Aisling Buckley, Agnes Kocsis, David Owen, Nicola Kalk, Rexford Newbould, Roger N. Gunn, Eugenii A. Rabiner, Graham P. Taylor
Journal of Nuclear Medicine Dec 2016, 57 (12) 1905-1912; DOI: 10.2967/jnumed.116.175083

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Evidence of Brain Inflammation in Patients with Human T-Lymphotropic Virus Type 1–Associated Myelopathy (HAM): A Pilot, Multimodal Imaging Study Using 11C-PBR28 PET, MR T1-Weighted, and Diffusion-Weighted Imaging
Rahul Dimber, Qi Guo, Courtney Bishop, Adine Adonis, Aisling Buckley, Agnes Kocsis, David Owen, Nicola Kalk, Rexford Newbould, Roger N. Gunn, Eugenii A. Rabiner, Graham P. Taylor
Journal of Nuclear Medicine Dec 2016, 57 (12) 1905-1912; DOI: 10.2967/jnumed.116.175083
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Keywords

  • HTLV1
  • HAM
  • neuroinflammation
  • MRI
  • DWI
  • PET
  • [11C] PBR28
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