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PML affects patients with various underlying conditions, such as HIV\/AIDS, hematological malignancies, organ transplants, autoimmune diseases, or multiple sclerosis particularly those receiving disease-modifying therapies. MRI plays a crucial role in diagnosis, demonstrating characteristic findings across multiple sequences, including T2-weighted imaging (T2WI)\/fluid-attenuated inversion recovery (FLAIR), T1-weighted imaging (T1WI), diffusion-weighted imaging (DWI), and susceptibility-weighted imaging (SWI). Early stage markers first appear as a cluster of punctate high-signal areas in T2WI (the \"punctate pattern\") and later develop into a distribution of oval-shaped lesions of varying sizes, commonly referred to as the \"milky way appearance.\" Lesions typically show T2WI\/FLAIR hyperintensity, T1WI hypointensity, and DWI hyperintensity. Recent findings highlight the significance of SWI hypointensity as a potential early marker. The prognosis varies significantly depending on the underlying condition and timing of diagnosis, with mortality rates ranging from 20 to 90%. Early detection, particularly in asymptomatic stages, significantly improves survival rates, emphasizing the importance of regular MRI screening in high-risk patients. Diagnostic challenges include low JCV DNA levels in cerebrospinal fluid (CSF), particularly in early stages and drug-associated cases, necessitating ultrasensitive PCR testing. This review provides an overview of PML's imaging characteristics, with particular emphasis on early diagnostic features using MRI, with a detailed understanding of PML's imaging characteristics across various stages and clinical subtypes, aiming to improve patient outcomes through early detection and intervention.<\/jats:p>","DOI":"10.1007\/s11604-025-01837-y","type":"journal-article","created":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T03:07:05Z","timestamp":1753067225000},"page":"1908-1925","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Overview of MRI findings in progressive multifocal leukoencephalopathy"],"prefix":"10.1007","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9518-0408","authenticated-orcid":false,"given":"Koichiro","family":"Mori","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariko","family":"Kurokawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masafumi","family":"Harada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuo","family":"Nakamichi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideo","family":"Arai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaki","family":"Takao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasunobu","family":"Takaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiharu","family":"Miura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,21]]},"reference":[{"key":"1837_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. 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