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Updated: Oct 19, 2025
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Association of iron rim lesions with brain and cervical cord volume in relapsing multiple sclerosis
Claudia E Weber1, Julia Krämer2, Matthias Wittayer1
1Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Theodor-Kutzer-Ufer 1 - 3, 68167, Mannheim, Germany.
Objectives:
In multiple sclerosis (MS), iron rim lesions (IRLs) are indicators of chronic low-grade inflammation and ongoing tissue destruction. The aim of this study was to assess the relationship of IRLs with clinical measures and magnetic resonance imaging (MRI) markers, in particular brain and cervical cord volume.
Methods:
Clinical and MRI parameters from 102 relapsing MS patients (no relapses for at least 6 months, no contrast-enhancing lesions) were included; follow-up data obtained after 12 months was available in 49 patients. IRLs were identified on susceptibility-weighted images (SWIs). In addition to standard brain and spinal cord MRI parameters, normalised cross-sectional area (nCSA) of the upper cervical cord was calculated.
Results:
Thirty-eight patients had at least one IRL on SWI MRI. At baseline, patients with IRLs had higher EDSS scores, higher lesion loads (brain and spinal cord), and lower cortical grey matter volumes and a lower nCSA. At follow-up, brain atrophy rates were higher in patients with IRLs. IRLs correlated spatially with T1-hypointense lesions.
Conclusions:
Relapsing MS patients with IRLs showed more aggressive MRI disease characteristics in both the cross-sectional and longitudinal analyses.
Key Points:
• Multiple sclerosis patients with iron rim lesions had higher EDSS scores, higher brain and spinal cord lesion loads, lower cortical grey matter volumes, and a lower normalised cross-sectional area of the upper cervical spinal cord. • Iron rim lesions are a new lesion descriptor obtained from susceptibility-weighted MRI. Our data suggests that further exploration of this lesion characteristic in regard to a poorer prognosis in multiple sclerosis patients is warranted.
Insights
Multiple sclerosis patients with iron rim lesions (IRLs) show more aggressive disease on MRI, including higher lesion loads and brain atrophy. These findings suggest IRLs may indicate a poorer prognosis in MS.
Area of Science:
- Neurology
- Radiology
- Immunology
Background:
- Iron rim lesions (IRLs) are associated with chronic inflammation and tissue destruction in multiple sclerosis (MS).
- Understanding the clinical and imaging correlates of IRLs is crucial for assessing disease progression.
Purpose of the Study:
- To investigate the relationship between IRLs and clinical measures in relapsing MS patients.
- To assess the association of IRLs with magnetic resonance imaging (MRI) markers, including brain and cervical cord volume.
Main Methods:
- 102 relapsing MS patients with available clinical and MRI data were analyzed.
- IRLs were identified using susceptibility-weighted imaging (SWI).
- Brain and spinal cord volumes, including normalized cross-sectional area (nCSA) of the cervical cord, were assessed.
Main Results:
- 38 patients presented with at least one IRL.
- Patients with IRLs exhibited higher EDSS scores, increased brain and spinal cord lesion loads, and reduced cortical grey matter and cervical cord volumes at baseline.
- Longitudinal analysis revealed higher brain atrophy rates in patients with IRLs.
Conclusions:
- IRLs are linked to more aggressive MRI-detected disease characteristics in relapsing MS patients.
- These findings highlight IRLs as a potential imaging biomarker for predicting a poorer prognosis in MS.
- Further research into IRLs on SWI MRI is warranted to explore their prognostic value.
