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Longitudinal clinical study of patients with iron rim lesions in multiple sclerosis

Altokhis, Amjad I.; Hibbert, Aimee M.; Allen, Christopher M.; Mougin, Olivier; Alotaibi, Abdulmajeed; Lim, Su Yin; Constantinescu, Cris S.; Abdel-Fahim, Rasha; Evangelou, Nikos

Longitudinal clinical study of patients with iron rim lesions in multiple sclerosis Thumbnail


Amjad I. Altokhis

Aimee M. Hibbert

Christopher M. Allen

Abdulmajeed Alotaibi

Su Yin Lim

Cris S. Constantinescu

Rasha Abdel-Fahim


Background: Iron rims (IRs) surrounding white matter lesions (WMLs) are suggested to predict a more severe disease course. Only small longitudinal cohorts of patients with and without iron rim lesions (IRLs) have been reported so far. Objective: To assess whether the presence and number of IRLs in patients with clinically isolated syndrome (CIS) and multiple sclerosis (MS) are associated with long-term disability or progressive disease. Methods: Ninety-one CIS/MS patients were recruited between 2008 and 2013 and scanned with 7 T magnetic resonance imaging (MRI). Expanded Disability Status Scale (EDSS) was used to calculate Age-related Multiple Sclerosis Severity Score (ARMSS) at the time of scan and at the latest clinical follow-up after 9 years. WMLs were assessed for the presence of IRL using Susceptibility weighted imaging (SWI)-filtered phase images. Results: In all, 132 IRLs were detected in 42 patients (46%); 9% of WMLs had IRs; 54% of the cohort had no rims, 30% had 1–3 rims and 16% had ⩾4. Patients with IRL had a higher EDSS and ARMSS. Presence of IRL was also a predictor of long-term disability, especially in patients with ⩾4 IRLs. IRLs have a greater impact on disability compared to the WML number and volume. Conclusion: The presence and number of perilesional IR on MRI hold prognostic value for long-term clinical disability in MS.


Altokhis, A. I., Hibbert, A. M., Allen, C. M., Mougin, O., Alotaibi, A., Lim, S. Y., …Evangelou, N. (2022). Longitudinal clinical study of patients with iron rim lesions in multiple sclerosis. Multiple Sclerosis Journal, 28(14), 2202-2211.

Journal Article Type Article
Acceptance Date Jun 30, 2022
Online Publication Date Aug 24, 2022
Publication Date 2022-12
Deposit Date Jul 26, 2022
Publicly Available Date Aug 24, 2022
Journal Multiple Sclerosis Journal
Print ISSN 1352-4585
Electronic ISSN 1477-0970
Publisher SAGE Publications
Peer Reviewed Peer Reviewed
Volume 28
Issue 14
Pages 2202-2211
Keywords Neurology (clinical); Neurology
Public URL
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