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Updated: Aug 22, 2025
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
What is the potential of paramagnetic rim lesions as diagnostic indicators in multiple sclerosis?
Maria Sofia Martire1, Lucia Moiola1, Maria Assunta Rocca1,2,3
1Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Introduction:
In multiple sclerosis (MS), paramagnetic rim lesions (PRLs) on MRI identify a subset of chronic active lesions (CALs), which have been linked through clinical and pathological studies to more severe disease course and greater disability accumulation. Beside their prognostic relevance, increasing evidence supports the use of PRL as a diagnostic biomarker.
Areas Covered:
This review summarizes the most recent updates regarding the MRI pathophysiology of PRL, their prevalence in MS (by clinical phenotypes) vs mimicking conditions, and their potential role as diagnostic MS biomarkers. We searched PubMed with terms including 'multiple sclerosis' AND 'paramagnetic rim lesions' OR 'iron rim lesions' OR 'rim lesions' for manuscripts published between January 2008 and July 2022.
Expert Opinion:
Current research suggests that PRL can improve the diagnostic specificity and the overall accuracy of MS diagnosis when used together with the dissemination in space MRI criteria and the central vein sign. Nevertheless, future prospective multicenter studies should further define the real-world prevalence and specificity of PRL. International guidelines are needed to establish methodological criteria for PRL identification before its implementation into clinical practice.
Insights
Paramagnetic rim lesions (PRLs) on MRI indicate active lesions in multiple sclerosis (MS), suggesting a role as a diagnostic biomarker. Further research is needed to establish their clinical utility.
Area of Science:
- Neurology
- Radiology
- Immunology
Background:
- Paramagnetic rim lesions (PRLs) on MRI signify active lesions in multiple sclerosis (MS), correlating with disease severity and disability.
- PRLs are increasingly recognized for their potential as diagnostic biomarkers in MS.
- Understanding PRL pathophysiology and prevalence is crucial for MS diagnosis and prognosis.
Approach:
- This review synthesizes recent findings on the MRI pathophysiology of PRL.
- It examines PRL prevalence across MS phenotypes and mimics.
- The review assesses the potential of PRL as a diagnostic biomarker for MS.
Key Points:
- PRLs identify a subset of chronic active lesions (CALs) in MS.
- Evidence supports PRLs as prognostic indicators and potential diagnostic biomarkers.
- The review covers PRL pathophysiology, prevalence, and diagnostic utility.
Conclusions:
- PRLs may enhance MS diagnostic accuracy when combined with existing MRI criteria.
- Prospective multicenter studies are required to validate PRL prevalence and specificity.
- International guidelines are necessary for standardized PRL identification in clinical practice.
