Paramagnetic rims are a promising diagnostic imaging biomarker in multiple sclerosis
- PMID: 36017870
- PMCID: PMC9679799
- DOI: 10.1177/13524585221118677
Paramagnetic rims are a promising diagnostic imaging biomarker in multiple sclerosis
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.
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.
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References
-
- Solomon AJ, Corboy JR. The tension between early diagnosis and misdiagnosis of multiple sclerosis. Nat Rev Neurol 2017; 13(9): 567–572. - PubMed
-
- Thompson AJ, Banwell BL, Barkhof F, et al.. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol 2018; 17(2): 162–173. - PubMed
-
- Gaetani L, Prosperini L, Mancini A, et al.. 2017 revisions of McDonald criteria shorten the time to diagnosis of multiple sclerosis in clinically isolated syndromes. J Neurol 2018; 265(11): 2684–2687. - PubMed
-
- Beesley R, Anderson V, Harding KE, et al.. Impact of the 2017 revisions to McDonald criteria on the diagnosis of multiple sclerosis. Mult Scler 2018; 24(13): 1786–1787. - PubMed
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