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Meta-Analysis
. 2021 Sep 8;16(9):e0256845.
doi: 10.1371/journal.pone.0256845. eCollection 2021.

The prevalence of paramagnetic rim lesions in multiple sclerosis: A systematic review and meta-analysis

Koy Chong Ng Kee Kwong  1 , Daisy Mollison  1 , Rozanna Meijboom  1 , Elizabeth N York  1 , Agniete Kampaite  1 , Michael J Thrippleton  1 , Siddharthan Chandran  1 , Adam D Waldman  1
Affiliations
Meta-Analysis

The prevalence of paramagnetic rim lesions in multiple sclerosis: A systematic review and meta-analysis

Koy Chong Ng Kee Kwong et al. PLoS One. .

Abstract

Background: Recent findings from several studies have shown that paramagnetic rim lesions identified using susceptibility-based MRI could represent potential diagnostic and prognostic biomarkers in multiple sclerosis (MS). Here, we perform a systematic review and meta-analysis of the existing literature to assess their pooled prevalence at lesion-level and patient-level.

Methods: Both database searching (PubMed and Embase) and handsearching were conducted to identify studies allowing the lesion-level and/or patient-level prevalence of rim lesions or chronic active lesions to be calculated. Pooled prevalence was estimated using the DerSimonian-Laird random-effects model. Subgroup analysis and meta-regression were performed to explore possible sources of heterogeneity. PROSPERO registration: CRD42020192282.

Results: 29 studies comprising 1230 patients were eligible for analysis. Meta-analysis estimated pooled prevalences of 9.8% (95% CI: 6.6-14.2) and 40.6% (95% CI: 26.2-56.8) for rim lesions at lesion-level and patient-level, respectively. Pooled lesion-level and patient-level prevalences for chronic active lesions were 12.0% (95% CI: 9.0-15.8) and 64.8% (95% CI: 54.3-74.0), respectively. Considerable heterogeneity was observed across studies (I2>75%). Subgroup analysis revealed a significant difference in patient-level prevalence between studies conducted at 3T and 7T (p = 0.0312). Meta-regression analyses also showed significant differences in lesion-level prevalence with respect to age (p = 0.0018, R2 = 0.20) and disease duration (p = 0.0018, R2 = 0.48). Other moderator analyses demonstrated no significant differences according to MRI sequence, gender and expanded disability status scale (EDSS).

Conclusion: In this study, we show that paramagnetic rim lesions may be present in an important proportion of MS patients, notwithstanding significant variation in their assessment across studies. In view of their possible clinical relevance, we believe that clear guidelines should be introduced to standardise their assessment across research centres to in turn facilitate future analyses.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA flow diagram.
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram outlining literature review and study selection.
Fig 2
Fig 2. Random-effects forest plots showing the pooled lesion-level prevalence of (a) rim lesions and (b) chronic active lesions in patients with MS.
The lesion-level prevalence observed by each study is represented by a square, with the 95% confidence interval being represented by a horizontal line. The pooled lesion-level prevalence is represented by a diamond, with the width corresponding to the 95% confidence interval. Cases = Number of identified rim lesions/chronic active lesions; Total = Total number of lesions.
Fig 3
Fig 3. Random-effects forest plots showing the pooled patient-level prevalence of (a) rim lesions and (b) chronic active lesions in patients with MS.
The patient-level prevalence observed by each study is represented by a square, with the 95% confidence interval being represented by a horizontal line. The pooled patient-level prevalence is represented by a diamond, with the width corresponding to the 95% confidence interval. Cases = Number of patients with at least one rim lesion/chronic active lesion; Total = Total number of patients.
See this image and copyright information in PMC

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