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Paramagnetic rim lesions are associated with pathogenic CSF profiles and worse clinical status in multiple sclerosis:
Christopher C Hemond1, Jonggyu Baek2, Carolina Ionete3
1Department of Neurology, University of Massachusetts Chan Medical Center and University of Massachusetts Chan Medical School, Worcester, MA, USA.
Background:
Paramagnetic rims have been observed as a feature of some multiple sclerosis (MS) lesions on susceptibility-sensitive magnetic resonance imaging (MRI) and indicate compartmentalized inflammation.
Objective:
To investigate clinical, MRI, and intrathecal (cerebrospinal fluid, CSF) associations of paramagnetic rim lesions (PRLs) using 3T MRI in MS.
Methods:
This is a retrospective, cross-sectional analysis. All patients underwent 3T MRI using a T2*-weighted sequence with susceptibility postprocessing (susceptibility-weighted angiography (SWAN) protocol, GE). SWAN-derived filtered-phase maps and corresponding T2-FLAIR images were manually reviewed to determine PRL. Descriptive statistics, t-tests, and regression determined demographic, clinical, MRI, and CSF associations with PRL.
Results:
A total of 147 MS patients were included; 79 of whom had available CSF. Forty-three percent had at least one PRL. PRL status (presence/absence) did not vary by sex or Expanded Disability Status Scale (EDSS) but was associated with younger age, shorter disease duration, worse disease severity, high-efficacy therapy use, and poorer dexterity, as well as lower age-adjusted brain volumes and cognitive processing speeds. PRL status was moreover associated with blood-brain barrier disruption as determined by pathologically elevated albumin quotient. Sensitivity analyses remained supportive of these findings.
Conclusion:
PRLs, an emerging noninvasive biomarker of chronic neuroinflammation, are confirmed to be associated with greater disease severity and newly shown to be preliminarily associated with blood-brain barrier disruption.
Insights
Paramagnetic rim lesions (PRLs) in multiple sclerosis (MS) are linked to increased disease severity and blood-brain barrier disruption. These findings highlight PRLs as potential biomarkers for chronic neuroinflammation in MS patients.
Area of Science:
- Neuroimaging
- Neurology
- Immunology
Background:
- Paramagnetic rim lesions (PRLs) are observed in multiple sclerosis (MS) lesions using susceptibility-sensitive MRI.
- PRLs indicate compartmentalized inflammation within MS lesions.
Purpose of the Study:
- To investigate clinical, MRI, and intrathecal (cerebrospinal fluid, CSF) associations of paramagnetic rim lesions (PRLs) in MS.
- Utilize 3T MRI for enhanced detection and characterization of PRLs.
Main Methods:
- Retrospective, cross-sectional analysis of 147 MS patients.
- 3T MRI with T2*-weighted sequence and susceptibility postprocessing (SWAN protocol).
- Manual review of SWAN-filtered phase maps and T2-FLAIR images to identify PRLs; statistical analyses for associations.
Main Results:
- 43% of MS patients exhibited at least one PRL.
- PRL presence associated with younger age, shorter disease duration, worse disease severity, high-efficacy therapy use, poorer dexterity, reduced brain volumes, and slower cognitive processing speeds.
- PRL status correlated with blood-brain barrier disruption, indicated by elevated albumin quotient.
Conclusions:
- PRLs are confirmed noninvasive biomarkers of chronic neuroinflammation in MS.
- PRLs are associated with greater disease severity and preliminary evidence suggests a link to blood-brain barrier disruption.
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