Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Dec;28(14):2202-2211.
doi: 10.1177/13524585221114750. Epub 2022 Aug 24.

Longitudinal clinical study of patients with iron rim lesions in multiple sclerosis

Amjad I Altokhis  1 , Aimee M Hibbert  2 , Christopher M Allen  3 , Olivier Mougin  4 , Abdulmajeed Alotaibi  5 , Su-Yin Lim  6 , Cris S Constantinescu  7 , Rasha Abdel-Fahim  2 , Nikos Evangelou  3
Affiliations

Longitudinal clinical study of patients with iron rim lesions in multiple sclerosis

Amjad I Altokhis et al. Mult Scler. 2022 Dec.

Abstract

Background: Iron rims (IRs) surrounding white matter lesions (WMLs) are suggested to predict a more severe disease course. Only small longitudinal cohorts of patients with and without iron rim lesions (IRLs) have been reported so far.

Objective: To assess whether the presence and number of IRLs in patients with clinically isolated syndrome (CIS) and multiple sclerosis (MS) are associated with long-term disability or progressive disease.

Methods: Ninety-one CIS/MS patients were recruited between 2008 and 2013 and scanned with 7 T magnetic resonance imaging (MRI). Expanded Disability Status Scale (EDSS) was used to calculate Age-related Multiple Sclerosis Severity Score (ARMSS) at the time of scan and at the latest clinical follow-up after 9 years. WMLs were assessed for the presence of IRL using Susceptibility weighted imaging (SWI)-filtered phase images.

Results: In all, 132 IRLs were detected in 42 patients (46%); 9% of WMLs had IRs; 54% of the cohort had no rims, 30% had 1-3 rims and 16% had ⩾4. Patients with IRL had a higher EDSS and ARMSS. Presence of IRL was also a predictor of long-term disability, especially in patients with ⩾4 IRLs. IRLs have a greater impact on disability compared to the WML number and volume.

Conclusion: The presence and number of perilesional IR on MRI hold prognostic value for long-term clinical disability in MS.

Keywords: Multiple sclerosis (MS); biomarkers; iron rim lesion (IRL); magnetic resonance imaging (MRI); white matter lesion (WML).

PubMed Disclaimer

Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship and/or publication of this article: A.I.A., A.M.H, A.A., S.-Y.L. and O.M. have nothing to declare. C.M.A. has received speaker honorarium from the Multiple Sclerosis Academy. R.A.-F. has participated on advisory boards, received travel grants and attended educational programmes sponsored by Roche and Novartis. C.S.C. has received grants, personal fees and nonfinancial support from Biogen; and personal fees and nonfinancial support from Novartis, Teva, Merck and Sanofi Genzyme. N.E. is a member of the advisory board for Biogen, Merck, Novartis and Roche; he has received grant income from the MS Society, MRC, PCORI and NIHR.

Figures

Figure 1.
Figure 1.
Flowchart summarises the study selection.
Figure 2.
Figure 2.
(a) Typical appearance of two lesions with rims on SWI-filtered phase image corresponding with (b) T1-weighted (MPRAGE). Enlarged images of the lesions indicated using the white arrows from different patients are shown in the black box with the characteristic hypointense rim surrounding most of the lesion.
Figure 3.
Figure 3.
Histogram illustrating the number of iron rim lesions. Lesions were classified into three groups based on rim presence.
Figure 4.
Figure 4.
ARMSS at baseline and current clinical follow-up in patients with and without IRL. The median baseline ARMSS of the whole cohort was 5.4 (IQR 2.8–7.6). Patients with at least one IRL had a higher baseline ARMSS (6.7; IQR 3.1–8.1) compared to those without IRL (5.0; IQR 2.2–6.5).
Figure 5.
Figure 5.
ARMSS at baseline and current clinical follow-up in IRL patients. The number of IRLs were grouped to (a; 0 IRLs, 1–3 IRLs and ⩾4 IRLs), (b; less than 4 IRLs and 4 or more rims).
Figure 6.
Figure 6.
ROC curve for the cut-offs of iron rim lesions number. Reference line (in green).
See this image and copyright information in PMC

References

    1. Rosati G. The prevalence of multiple sclerosis in the world: An update. Neurol Sci 2001; 22(2): 117–139. - PubMed
    1. Ontaneda D, Tallantyre E, Kalincik T, et al.. Early highly effective versus escalation treatment approaches in relapsing multiple sclerosis. Lancet Neurol 2019; 18(10): 973–980. - PubMed
    1. Rotstein D, Montalban X. Reaching an evidence-based prognosis for personalized treatment of multiple sclerosis. Nat Rev Neurol 2019; 15(5): 287–300. - PubMed
    1. Allen CM, Mowry E, Tintore M, et al.. Prognostication and contemporary management of clinically isolated syndrome. J Neurol Neurosurg Psychiatry 2021; 92(4): 391–397. - PubMed
    1. Absinta M, Sati P, Schindler M, et al.. Persistent 7-tesla phase rim predicts poor outcome in new multiple sclerosis patient lesions. J Clin Invest 2016; 126(7): 2597–2609. - PMC - PubMed