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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

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Isobel Meaton

Amjad Altokhis

Christopher Martin Allen

Margareta A. Clarke

Tim Sinnecker

Dominik Meier

Christian Enzinger

Massimiliano Calabrese

Nicola De Stefano

Alain Pitiot

Antonio Giorgio

Menno M Schoonheim

Friedemann Paul

Mikolaj A. Pawlak

Reinhold Schmidt

Cristina Granziera

Ludwig Kappos

Xavier Montalban

Àlex Rovira

Jens Wuerfel


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.


Meaton, I., Altokhis, A., Allen, C. M., Clarke, M. A., Sinnecker, T., Meier, D., …Evangelou, N. (2022). Paramagnetic rims are a promising diagnostic imaging biomarker in multiple sclerosis. Multiple Sclerosis Journal,

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
Keywords Neurology (clinical), Neurology
Public URL
Publisher URL


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