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Updated: Sep 10, 2025
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Association of paramagnetic rim lesions with patient-reported neuropsychiatric symptoms in multiple sclerosis
Dimitrios C Ladakis1, Mahsa Ghajarzadeh1, Pavan Bhargava1
1Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Background:
Paramagnetic rim lesions (PRLs) mark chronic active lesions in multiple sclerosis (MS) and have been linked to disability progression and objective cognitive decline, but their relationship with invisible symptoms such as fatigue, mood disturbance and perceived cognition remains unclear.
Methods:
We prospectively enrolled adults with MS who underwent 3T susceptibility-weighted imaging. Supratentorial PRLs were counted and participants were categorised into 0, 1-3 or > 3 PRLs. Neuro-QoL T-scores for fatigue, depression, anxiety and perceived cognition were collected at baseline and annually for up to five years (median 3.1 years, 419 person-visits). Cross-sectional associations were examined with multivariable linear regression; longitudinal change was modelled with linear mixed-effects models adjusted for age, sex, race and MS course, applying false-discovery-rate correction.
Results:
Among 92 adults with MS (mean age 51 ± 13 years; 78 % women), 41 participants (45 %) had no PRLs, 27 (29 %) had 1-3, and 24 (26 %) had > 3. At baseline, PRL burden did not correlate with fatigue, depression, anxiety, or cognition (all FDR-adjusted p > 0.70). During follow-up, PRL category did not influence trajectories of fatigue, depression, or cognition. Participants with >3 PRLs experienced a modest annual reduction in anxiety (-1.8 T-score points/year; 95 % CI -3.05 to -0.56; FDR p = 0.02).
Conclusions:
Supratentorial PRL burden is not a major determinant of common invisible symptoms in MS. The unexpected inverse association with anxiety may in part reflect regression to the mean or adaptive coping over time and needs replication in larger cohorts incorporating lesion volume, location, and treatment exposure.
Insights
Paramagnetic rim lesions (PRLs) in multiple sclerosis (MS) do not significantly impact fatigue, depression, or cognition. A higher PRL count was unexpectedly linked to a slight decrease in anxiety over time.
Area of Science:
- Neuroimaging
- Neurology
- Psychiatry
Background:
- Paramagnetic rim lesions (PRLs) indicate active lesions in multiple sclerosis (MS).
- PRLs are associated with disability and cognitive decline.
- The link between PRLs and invisible MS symptoms like fatigue and mood is unclear.
Purpose of the Study:
- To investigate the association between supratentorial PRL burden and invisible symptoms in MS.
- To determine if PRLs influence the progression of fatigue, mood disturbance, and perceived cognition.
Main Methods:
- 92 adults with MS underwent 3T susceptibility-weighted imaging to count supratentorial PRLs.
- Participants were categorized by PRL count (0, 1-3, >3).
- Neuro-QoL T-scores for fatigue, depression, anxiety, and cognition were assessed annually for up to five years.
Main Results:
- PRL burden did not correlate with baseline fatigue, depression, anxiety, or cognition.
- PRL category did not affect the longitudinal trajectories of fatigue, depression, or cognition.
- Participants with >3 PRLs showed a modest annual decrease in anxiety (FDR p=0.02).
Conclusions:
- Supratentorial PRL burden is not a primary driver of common invisible symptoms in MS.
- The inverse association with anxiety requires further investigation, potentially due to regression to the mean or coping mechanisms.
- Larger studies are needed to confirm findings, considering lesion volume, location, and treatment.
