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PML-related disability complicates the MRI monitoring needed to assess treatment interventions in clinical trial or compassionate use settings. Portable ultra-low-field MRI (pULF-MRI) offers a convenient approach when such frequent imaging is needed. We evaluated the potential utility of pULF-MRI as an adjunctive tool for decreasing the burden of clinical study participation and clinical management in PML.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>We examined paired high-field (HF) and pULF-MRI scans from 11 patients, aged 49\u2009\u00b1\u200915\u00a0years. pULF-MRI images with corresponding HF-MRI were coupled to depict key imaging findings of PML, including three patients with longitudinal evaluations, one with bedside pULF-MRI. The images were then independently assessed by two blinded raters, not involved in image acquisition or initial evaluations, who sequentially rated diagnostic accuracy of pULF-MRI scans compared to the HF-MRI. Longitudinal evaluations were performed for three patients, one with bedside pULF-MRI<jats:bold>.<\/jats:bold>\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>T2-FLAIR lesions were detected with pULF-ULF in all cases when present on HF-MRI. Median sensitivity and specificity were 62% and 100%, respectively. T1WI hypointense areas showed similar performance. Focal volume loss was present in 8\/11 HF-MRI scans, with sensitivity and specificity of detection by pULF-MRI of 100% and 94%, respectively. Contrast enhancement was seen in a single case on both pULF- and HF-MRI. Follow-up pULF-MRI showed lesion changes in two cases, and stable findings in one case, consistent with HF-MRI.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Discussion<\/jats:title>\n            <jats:p>pULF-MRI shows promise in evaluation and monitoring of PML, showing moderate-to-high accuracy even when evaluations were unaided by HF-MRI. Our results highlight a potential application of pULF-MRI for facilitating participation in PML clinical research and more generally as a way to reduce burden of clinical management for this disabled patient population.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00415-025-12938-z","type":"journal-article","created":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T13:30:41Z","timestamp":1739280641000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Portable ultra-low-field MRI for progressive multifocal leukoencephalopathy: Case studies, sensitivity, and potential applications"],"prefix":"10.1007","volume":"272","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3716-2196","authenticated-orcid":false,"given":"Serhat V.","family":"Okar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karan D.","family":"Kawatra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley A.","family":"Thommana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela C.","family":"Vultorius","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Govind","family":"Nair","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda I.","family":"Gait\u00e1n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gina","family":"Norato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yair","family":"Mina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Fletcher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel S.","family":"Reich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Cortese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,2,11]]},"reference":[{"key":"12938_CR1","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1038\/s41582-020-00427-y","volume":"17","author":"I Cortese","year":"2021","unstructured":"Cortese I, Reich DS, Nath A (2021) Progressive multifocal leukoencephalopathy and the spectrum of JC virus-related disease. 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KDK has nothing to disclose. AAT has nothing to disclose. DCV has nothing to disclose.GN has nothing to disclose. MIG has nothing to disclose. GN has nothing to disclose. YM has nothing to disclose. AF has nothing to disclose. DSR has received research funding from Abata and Sanofi, unrelated to the current study. IC is a shareholder of Nouscom AG, Keires AG and PDC*line pharma, unrelated to the current study. The authors have no competing interests related to the content presented in this study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}},{"value":"The data included in this research was acquired following the approval of the Institutional Review Board and after obtaining written informed consent from the participants, as part of the National Institute of Neurological Disorders and Stroke's \u201cNatural History Study of Progressive Multifocal Leukoencephalopathy\u201d protocol (NCT01730131).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Participants or their relatives provided consent for publication during the informed consent process within the study protocol. We affirm that the bedside scan photo provided in Fig.\u00a0 does not contain any personally identifiable information, and we have obtained consent from the patient.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}],"article-number":"193"}}