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. 2023 May 26;13(11):1866.
doi: 10.3390/diagnostics13111866.

Iron Rim Lesions as a Specific and Prognostic Biomarker of Multiple Sclerosis: 3T-Based Susceptibility-Weighted Imaging

Sooyoung Kim  1 , Eun Kyoung Lee  2 , Chang June Song  3 , Eunhee Sohn  1
Affiliations

Iron Rim Lesions as a Specific and Prognostic Biomarker of Multiple Sclerosis: 3T-Based Susceptibility-Weighted Imaging

Sooyoung Kim et al. Diagnostics (Basel). .

Abstract

This study aimed to identify the clinical significance of iron rim lesions (IRLs) in distinguishing multiple sclerosis (MS) from other central nervous system (CNS) demyelinating diseases, determine the relationship between IRLs and disease severity, and understand the long-term dynamic changes in IRLs in MS. We retrospectively evaluated 76 patients with CNS demyelinating diseases. CNS demyelinating diseases were classified into three groups: MS (n = 30), neuromyelitis optica spectrum disorder (n = 23), and other CNS demyelinating diseases (n = 23). MRI images were obtained using conventional 3T MRI including susceptibility-weighted imaging. Sixteen of 76 patients (21.1%) had IRLs. Of the 16 patients with IRLs, 14 were in the MS group (87.5%), indicating that IRLs were significantly specific for MS. In the MS group, patients with IRLs had a significantly higher number of total WMLs, experienced more frequent recurrence, and were treated more with second-line immunosuppressive agents than were patients without IRLs. In addition to IRLs, T1-blackhole lesions were observed more frequently in the MS group than in the other groups. IRLs are specific for MS and could represent a reliable imaging biomarker to improve the diagnosis of MS. Additionally, the presence of IRLs seems to reflect more severe disease progression in MS.

Keywords: diagnostic imaging; disease progression; iron; multiple sclerosis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Dynamic changes in iron rim lesions (IRLs) in the multiple sclerosis (MS) group. In our study, of a total of 30 patients classified as the MS group, IRLs were observed in 14 patients. Overall, IRLs in the MS group were expanded in 7 patients (50.0%), unchanged in 4 patients (28.6%), and decreased in 2 patients (14.3%) during the follow-up period. The expansion of IRLs was mostly observed in the first to second (42.9%, 6 of 14 patients) and the second to third (28.6%, 4 of 14 patients) MRI scans. On the other hand, patients with decreased dynamics of IRLs were observed more at the third to fourth MRI scan than at the earlier scan. Thirteen patients could be analyzed in the MRI (1→2) column, 9 patients in the MRI (2→3) column, and 6 patients in the MRI (3→4) column.
Figure 2
Figure 2
Serial brain magnetic resonance imaging of a 26-year-old male patient with relapsing-remitting multiple sclerosis. (A–C) are rims in susceptibility-weighted images (SWIs) of the same axial plane. There are no iron rim lesions (IRLs) in the baseline (A) and 1-year follow-up images (B). However, in the 3-year follow-up images, the IRLs are observed in the left frontal deep white matter area (C). (D–F) are SWIs of the same axial plane. There are no IRLs in the baseline (D) either, but (E,F) show the new IRLs in the left frontal subcortical white matter area.
See this image and copyright information in PMC

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