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Updated: Jul 6, 2025
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Characteristics, Prevalence, and Clinical Relevance of Juxtacortical Paramagnetic Rims in Patients With Multiple
Riccardo Galbusera1, Erik Bahn1, Matthias Weigel1
1From the Neurology Clinic and Policlinic (R.G., M.W., A.C., P.-J.L., M.B., J.K., L.K., C.G.), Departments of Medicine, Clinical Research and Biomedical Engineering, Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, (R.G., M.W., A.C., P.-J.L., M.B., L.K., C.G.), Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB) Basel (R.G., M.W., A.C., P.-J.L., M.B., J.K., L.K., C.G.), Radiological Physics, Department of Radiology (M.W.), and Department of Clinical Research (S.A.S.), University Hospital Basel and University of Basel, Switzerland; Institute of Neuropathology (E.B., J.F., W.B., C.S.), University Medical Center Göttingen, Germany; Department of Cognitive Neurology (P.D.), MR-Research in Neurosciences, University Medical Center Göttingen, Germany; Institute of Diagnostic and Interventional Neuroradiology (R.R.), Bern University Hospital, University of Bern, Switzerland; and National Institute of Neurological Disorders and Stroke (G.N.), Bethesda, MD.
Background And Objectives:
A subgroup of patients with multiple sclerosis (MS) presents focal paramagnetic rims at the border between cortex and white matter (juxtacortical paramagnetic rims [JPRs]). We investigated the presence of this finding in our in vivo MS cohort and explored its potential clinical relevance. Moreover, we exploited postmortem MRI of fixed whole MS brains to (1) detect those rims and (2) investigate their histologic correlation.
Methods:
Quantitative susceptibility mapping (QSM) and magnetization-prepared 2 rapid acquisition gradient-echo (MP2RAGE) images at 3T-MRI of 165 patients with MS from the in vivo cohort were screened for JPRs and the presence of cortical lesions. Five postmortem brains from patients with MS were imaged with 3T-MRI to obtain QSM and MP2RAGE sequences. Tissue blocks containing JPRs were excised and paraffin-embedded slices stained by immunohistochemistry for myelin basic protein (for myelin) and anti-CR3/43 (for major histocompatibility complex II-positive microglia/macrophages). DAB-Turnbull stain was performed to detect iron.
Results:
JPRs are present in approximately 10% of in vivo patients and are associated with increased cortical lesion load. One of the 5 postmortem brains showed JPRs. Histologically, JPRs correspond to an accumulation of activated iron-laden phagocytes and are associated with demyelination of the whole overlying cortical ribbon.
Discussion:
JPRs are a novel potential MRI biomarker of focal cortical demyelination, which seems related to global cortical pathology and might be useful for diagnostic and stratification purposes in a clinical setting.
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