Paramagnetic rims are a promising diagnostic imaging biomarker in multiple sclerosis. (December 2022)

• Record Type: Journal Article
• Authors: Meaton, Isobel; Altokhis, Amjad; Allen, Christopher Martin; Clarke, Margareta A; Sinnecker, Tim; Meier, Dominik; Enzinger, Christian; Calabrese, Massimiliano; De Stefano, Nicola; Pitiot, Alain; Giorgio, Antonio; Schoonheim, Menno M; Paul, Friedemann; Pawlak, Mikolaj A; Schmidt, Reinhold; Granziera, Cristina; Kappos, Ludwig; Montalban, Xavier; Rovira, Àlex; Wuerfel, Jens; Evangelou, Nikos
• Is Part Of: Multiple sclerosis. Volume 28:Number 14(2022)
• Page Start: 2212
• Page End: 2220
• Publication Date: 2022-12
• Subjects: Multiple sclerosis -- MRI -- CIS -- biomarkers; Central nervous system -- Diseases -- Periodicals; Myelin sheath -- Diseases -- Periodicals; Inflammation -- Periodicals; Multiple sclerosis -- Periodicals; Central Nervous System Diseases -- Periodicals; Demyelinating Diseases -- Periodicals; Inflammation -- Periodicals; Multiple Sclerosis -- Periodicals; Système nerveux central -- Maladies -- Périodiques; Gaine de myéline -- Maladies -- Périodiques; Inflammation (Pathologie) -- Périodiques; Sclérose en plaques -- Périodiques; Electronic journals; 616.834005
• DOI: 10.1177/13524585221118677
• Languages: English
• ISSNs: 1352-4585

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.