Paramagnetic rims are a promising diagnostic imaging biomarker in multiple sclerosis

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

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.

Citation

Meaton, I., Altokhis, A., Allen, C. M., Clarke, M. A., Sinnecker, T., Meier, D., Enzinger, C., Calabrese, M., De Stefano, N., Pitiot, A., Giorgio, A., Schoonheim, M. M., Paul, F., Pawlak, M. A., Schmidt, R., Granziera, C., Kappos, L., Montalban, X., Rovira, À., Wuerfel, J., & Evangelou, N. (2022). Paramagnetic rims are a promising diagnostic imaging biomarker in multiple sclerosis. Multiple Sclerosis Journal, https://doi.org/10.1177/13524585221118677

• Journal Article Type: Article
• Acceptance Date: Jul 12, 2022
• Online Publication Date: Aug 26, 2022
• Publication Date: Aug 26, 2022
• Deposit Date: Aug 26, 2022
• Publicly Available Date: Aug 26, 2022
• Journal: Multiple Sclerosis Journal
• Print ISSN: 1352-4585
• Electronic ISSN: 1477-0970
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1177/13524585221118677
• Keywords: Neurology (clinical), Neurology
• Public URL: https://nottingham-repository.worktribe.com/output/10366789
• Publisher URL: https://journals.sagepub.com/doi/full/10.1177/13524585221118677