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Updated: Mar 21, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Paramagnetic Rim Lesions in Highly Active Multiple Sclerosis at the Time of Disease Diagnosis: Prevalence Data and
Alessandra Cicia1,2, Matteo Lucchini1,2, Gianluca Di Fiore3
1Centro di Ricerca Per la Sclerosi Multipla "Anna Paola Batocchi", Department of Neurosciences, Università Cattolica del Sacro Cuore, Rome, Italy.
Background:
Paramagnetic rim lesions (PRLs) are emerging MRI biomarkers of smoldering inflammation in multiple sclerosis with prognostic relevance1. However, their prevalence in the early stages of the disease remains underexplored.
Objective:
This prospective cohort study investigated the prevalence, anatomical distribution, and clinical significance of PRLs in newly diagnosed relapsing MS patients with high disease activity and explored their associations with conventional and non-conventional MRI measures, serum neurofilament light chain (sNfL), and clinical outcomes.
Methods:
We enrolled treatment-naïve patients who had received an MS diagnosis in the previous 12 months. Patients underwent 3 T brain and spinal MRI including susceptibility-weighted imaging at baseline, 6, and 12 months, along with neurological and cognitive assessments and sNfL sampling.
Results:
The cohort consisted of 21 patients, with a mean age of 31 and median disease duration of 9 months (IQR 4-17). Median EDSS score was 1.5. All patients presented with spinal cord lesions and 38% showed Gd + lesions. PRLs were detected in 76%, with a mean of 4.9 lesions per subject. Higher PRL burden correlated with greater T2 lesion volume and cortical lesion count, higher EDSS, reduced SDMT scores, and elevated baseline sNfL. PRLs remained stable over 12 months despite treatment; two new PRLs emerged at month 12. sNfL levels were higher in patients with ≥ 4 PRLs and decreased in all during follow-up.
Conclusions:
Paramagnetic rim lesions (PRLs) are detectable early in RMS and correlate with a more severe clinical and radiological profile. The combined assessment of PRLs and CLs may improve disease monitoring and guide personalized treatment.
Insights
Paramagnetic rim lesions (PRLs) are common in early multiple sclerosis (MS) and indicate a more severe disease course. Monitoring PRLs alongside cortical lesions may enhance personalized MS treatment strategies.
Area of Science:
- Neurology
- Radiology
- Immunology
Background:
- Paramagnetic rim lesions (PRLs) are emerging MRI biomarkers indicating smoldering inflammation in multiple sclerosis (MS).
- Their prevalence and prognostic significance in early MS stages are not well understood.
Purpose of the Study:
- To investigate the prevalence, distribution, and clinical significance of PRLs in newly diagnosed relapsing-remitting MS (RRMS) patients.
- To explore associations between PRLs and MRI measures, serum neurofilament light chain (sNfL), and clinical outcomes.
Main Methods:
- Prospective cohort study of treatment-naïve RRMS patients within 12 months of diagnosis.
- 3T brain and spinal MRI with susceptibility-weighted imaging at baseline, 6, and 12 months.
- Neurological, cognitive assessments, and sNfL sampling.
Main Results:
- PRLs detected in 76% of 21 patients; mean 4.9 PRLs/subject.
- Higher PRL burden correlated with increased T2 lesion volume, cortical lesions, EDSS, reduced SDMT scores, and elevated baseline sNfL.
- PRLs were stable over 12 months, with sNfL levels higher in patients with ≥4 PRLs.
Conclusions:
- PRLs are detectable early in RRMS and associated with a more severe clinical and radiological profile.
- Combined assessment of PRLs and cortical lesions (CLs) may improve MS disease monitoring.
- This approach could guide personalized treatment strategies for MS patients.
