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Updated: Jun 14, 2025
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Prognostic significance of paramagnetic rim lesions in multiple sclerosis: A systematic review
Adon Toru Asahina1, Joe Lu2, Pooja Chugh3
1Flinders Medical Centre, Bedford Park, SA 5042, Australia; South Australia Medical Imaging, Adelaide, SA 5000, Australia; Royal Adelaide Hospital, Adelaide, SA 5000, Australia; Queen Elizabeth Hospital, Woodville, SA 5011, Australia.
Abstract:
The diagnostic potential of paramagnetic rim lesions (PRLs) has been previously established; however, the prognostic significance of these lesions has not previously been consistently described. This study aimed to establish the prognostic role of PRLs in MS with respect to the Expanded Disability Status Scale (EDSS) and rates of disability progression. Databases of PubMed, EMBASE, Scopus and reference lists of selected articles were searched up to 29/04/2023. The review was conducted in accordance with PRISMA guidelines and was registered prospectively on PROSPERO (CRD42023422052). 7 studies were included in the final review. All of the eligible studies found that patients with PRLs tend to have higher baseline EDSS scores. Longitudinal assessments revealed greater EDSS progression in patients with PRLs over time in most studies. However, the effect of location of PRLs within the central nervous system were not assessed across the studies. Only one study investigated progression independent of relapse activity (PIRA) and showed that this clinical entity occurred in a greater proportion in patients with PRLs. This review supports PRLs as a predictor of EDSS progression. This measure has widespread applicability, however further multicentre studies are needed. Future research should explore the impact of PRLs on silent disability, PIRA, take into account different MS phenotypes and the topography of PRLs in prognosis.
Insights
Paramagnetic rim lesions (PRLs) in multiple sclerosis (MS) are linked to worse disability outcomes. Patients with PRLs show higher baseline Expanded Disability Status Scale (EDSS) scores and faster progression, indicating prognostic value.
Area of Science:
- Neuroimmunology
- Neuroimaging
- Clinical Neurology
Background:
- Paramagnetic rim lesions (PRLs) are a recognized diagnostic marker in multiple sclerosis (MS).
- The prognostic significance of PRLs regarding long-term disability progression in MS remains incompletely understood.
- This systematic review aimed to elucidate the prognostic role of PRLs in MS, focusing on Expanded Disability Status Scale (EDSS) and disability progression rates.
Approach:
- A comprehensive literature search was conducted across PubMed, EMBASE, and Scopus databases up to April 29, 2023.
- The review adhered to PRISMA guidelines and was prospectively registered on PROSPERO (CRD42023422052).
- Seven studies met the inclusion criteria for the final analysis.
Key Points:
- All included studies indicated that patients with PRLs exhibit higher baseline EDSS scores.
- Most studies demonstrated a trend towards greater EDSS progression over time in patients with PRLs.
- One study found a higher proportion of progression independent of relapse activity (PIRA) in patients with PRLs.
Conclusions:
- Paramagnetic rim lesions (PRLs) are supported as a predictor of EDSS progression in multiple sclerosis (MS).
- Further multicenter research is warranted to explore the impact of PRLs on silent disability, PIRA, and different MS phenotypes, considering lesion topography.
- The findings suggest widespread applicability of PRL assessment for MS prognosis.
