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. 2022 Dec;28(14):2212-2220.
doi: 10.1177/13524585221118677. Epub 2022 Aug 26.

Paramagnetic rims are a promising diagnostic imaging biomarker in multiple sclerosis

Isobel Meaton  1 , Amjad Altokhis  1 , Christopher Martin Allen  1 , Margareta A Clarke  2 , Tim Sinnecker  3 , Dominik Meier  3 , Christian Enzinger  4 , Massimiliano Calabrese  5 , Nicola De Stefano  6 , Alain Pitiot  7 , Antonio Giorgio  6 , Menno M Schoonheim  8 , Friedemann Paul  9 , Mikolaj A Pawlak  10 , Reinhold Schmidt  4 , Cristina Granziera  11 , Ludwig Kappos  11 , Xavier Montalban  12 , Àlex Rovira  13 , Jens Wuerfel  14 , Nikos Evangelou  1
Affiliations

Paramagnetic rims are a promising diagnostic imaging biomarker in multiple sclerosis

Isobel Meaton et al. Mult Scler. 2022 Dec.

Abstract

Background: White matter lesions (WMLs) on brain magnetic resonance imaging (MRI) in multiple sclerosis (MS) may contribute to misdiagnosis. In chronic active lesions, peripheral iron-laden macrophages appear as paramagnetic rim lesions (PRLs).

Objective: To evaluate the sensitivity and specificity of PRLs in differentiating MS from mimics using clinical 3T MRI scanners.

Method: This retrospective international study reviewed MRI scans of patients with MS (n = 254), MS mimics (n = 91) and older healthy controls (n = 217). WMLs, detected using fluid-attenuated inversion recovery MRI, were analysed with phase-sensitive imaging. Sensitivity and specificity were assessed for PRLs.

Results: At least one PRL was found in 22.9% of MS and 26.1% of clinically isolated syndrome (CIS) patients. Only one PRL was found elsewhere. The identification of ⩾1 PRL was the optimal cut-off and had high specificity (99.7%, confidence interval (CI) = 98.20%-99.99%) when distinguishing MS and CIS from mimics and healthy controls, but lower sensitivity (24.0%, CI = 18.9%-36.6%). All patients with a PRL showing a central vein sign (CVS) in the same lesion (n = 54) had MS or CIS, giving a specificity of 100% (CI = 98.8%-100.0%) but equally low sensitivity (21.3%, CI = 16.4%-26.81%).

Conclusion: PRLs may reduce diagnostic uncertainty in MS by being a highly specific imaging diagnostic biomarker, especially when used in conjunction with the CVS.

Keywords: CIS; MRI; Multiple sclerosis; biomarkers.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Figures

Figure 1.
Figure 1.
Consecutive slices of a paramagnetic rim lesion (with a central vein) detected using the fluid-attenuated inversion recovery (a.i. and b.i.) and phase-sensitive imaging (a.ii. and b.ii.), at 3T. As per the study protocol, the lesions demonstrate a hypointense, ring-like structure corresponding to the lesion edge which is present on at least two consecutive slices.
Figure 2.
Figure 2.
A box and whisker plot showing the mean and interquartile ranges of the number of white matter lesions per patient in each condition analysed. NMOSD: neuromyelitis optica spectrum disorder; Control: healthy control; CIS: clinically isolated syndrome; MS: multiple sclerosis.
Figure 3.
Figure 3.
The number of paramagnetic rim lesions per patient for each cohort with ⩾1 paramagnetic rim lesion. CIS: clinically isolated syndrome; MS: multiple sclerosis.
See this image and copyright information in PMC

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