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Paramagnetic Rim Lesions and Choroid Plexus Volume at Diagnosis Are Associated With Cognitive Progression Independent

Stefano Ziccardi1,2, Damiano Marastoni1,2, Agnese Tamanti1,2

  • 1Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.

Annals of Clinical and Translational Neurology
|July 8, 2026
PubMed

Insights

Paramagnetic rim lesions and enlarged choroid plexus in multiple sclerosis (MS) indicate smoldering inflammation. These markers predict cognitive decline independent of relapses or MRI activity, highlighting their role in disease progression.

Area of Science:

  • Neuroimmunology
  • Neuroimaging
  • Cognitive Neurology

Background:

  • Paramagnetic rim lesions (PRLs) and choroid plexus (CP) enlargement are indicators of smoldering inflammation in multiple sclerosis (MS).
  • The association between these MRI findings and cognitive decline, particularly progression independent of relapse/MRI activity (PIRMA), is not well understood.

Purpose of the Study:

  • To investigate the role of PRLs and CP volume in predicting cognitive progression in early relapsing-remitting MS patients.
  • To determine if these inflammatory markers are associated with cognitive PIRMA.

Main Methods:

  • Eighty-seven early relapsing-remitting MS patients were enrolled at diagnosis and followed longitudinally.
  • 3T-MRI was used to evaluate PRLs and CP volume at baseline.
  • Cognitive decline was assessed and classified as cognitive PIRMA.

Main Results:

  • A significant proportion of patients (63.2%) experienced meaningful cognitive decline, with 80.0% classified as cognitive PIRMA.
  • Both PRLs and larger CP volume at diagnosis were significantly associated with cognitive PIRMA.
  • These findings suggest PRLs and CP enlargement reflect subclinical inflammatory activity impacting cognition.

Conclusions:

  • Paramagnetic rim lesions and enlarged choroid plexus are associated with cognitive progression independent of clinical or MRI activity in early MS.
  • These imaging markers may serve as crucial indicators of smoldering disease activity impacting cognitive function in multiple sclerosis.
Keywords:
PIRAchoroid plexuscognitionmultiple sclerosisparamagnetic rim lesions

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