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. 2023 Mar;29(3):352-362.
doi: 10.1177/13524585221141964. Epub 2022 Dec 14.

Relationship between paramagnetic rim lesions and slowly expanding lesions in multiple sclerosis

Alberto Calvi  1 , Margareta A Clarke  2 , Ferran Prados  3 , Declan Chard  4 , Olga Ciccarelli  4 , Manel Alberich  2 , Deborah Pareto  2 , Marta Rodríguez Barranco  5 , Jaume Sastre-Garriga  5 , Carmen Tur  6 , Alex Rovira  2 , Frederik Barkhof  7
Affiliations

Relationship between paramagnetic rim lesions and slowly expanding lesions in multiple sclerosis

Alberto Calvi et al. Mult Scler. 2023 Mar.

Abstract

Background: Magnetic resonance imaging (MRI) markers for chronic active lesions in MS include slowly expanding lesions (SELs) and paramagnetic rim lesions (PRLs).

Objectives: To identify the relationship between SELs and PRLs in MS, and their association with disability.

Methods: 61 people with MS (pwMS) followed retrospectively with MRI including baseline susceptibility-weighted imaging, and longitudinal T1 and T2-weighted scans. SELs were computed using deformation field maps; PRLs were visually identified. Mixed-effects models assessed differences in Expanded Disability Status Scale (EDSS) score changes between the group defined by the presence of SELs and or PRLs.

Results: The median follow-up time was 3.2 years. At baseline, out of 1492 lesions, 616 were classified as SELs, and 80 as PRLs. 92% of patients had ⩾ 1 SEL, 56% had ⩾ 1 PRL, while both were found in 51%. SELs compared to non-SELs were more likely to also be PRLs (7% vs. 4%, p = 0.027). PRL counts positively correlated with SEL counts (ρ= 0.28, p = 0.03). SEL + PRL + patients had greater increases in EDSS over time (beta = 0.15/year, 95% confidence interval (0.04, 0.27), p = 0.009) than SEL+PRL-patients.

Conclusion: SELs are more numerous than PRLs in pwMS. Compared with either SELs or PRLs found in isolation, their joint occurrence was associated with greater clinical progression.

Keywords: Chronic active lesions; multiple sclerosis; paramagnetic rim lesions (PRLs); slowly expanding lesions (SELs); susceptibility-weighted imaging (SWI); volumetric MRI.

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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.
Stacked bar plot showing the total number of lesions classified as SEL or non-SEL, and the correspondent number of PRL within each subtype. The figure, drawn with R, shows the counts of lesions divided between the SEL and the non-SEL categories, and the corresponding PRLs in each subtype. The proportion of PRLs was higher among the SELs than among the non-SELs (7% vs. 4%, p = 0.027).
Figure 2.
Figure 2.
Example of a PRL at baseline and the correspondence to a SEL. The images show from left to right: SWI at baseline (the top left rectangle shows a magnification of the paramagnetic rim lesion), FLAIR with lesion mask countered in red, Jacobian map superimposed indicating that the PRL corresponds to a SEL. The images are from a 45-year-old person with a CIS and the MRI was performed 4 months after onset. At baseline the EDSS was 0 and last follow-up (~4 years) was 1.5. CIS: clinically isolated syndrome; EDSS: Expanded Disability Status Scale; PRL: paramagnetic rim lesion; FLAIR: fluid-attenuated inversion recovery; PRL: paramagnetic rim lesion; SWI: susceptibility-weighted imaging; SEL: slowly expanding lesion.
See this image and copyright information in PMC

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