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- Title
Paramagnetic rims are a promising diagnostic imaging biomarker in multiple sclerosis.
- Authors
Meaton, Isobel; Altokhis, Amjad; Allen, Christopher Martin; Clarke, Margareta A; Sinnecker, Tim; Meier, Dominik; Enzinger, Christian; Calabrese, Massimiliano; De Stefano, Nicola; Pitiot, Alain; Giorgio, Antonio; Schoonheim, Menno M; Paul, Friedemann; Pawlak, Mikolaj A; Schmidt, Reinhold; Granziera, Cristina; Kappos, Ludwig; Montalban, Xavier; Rovira, Àlex; Wuerfel, Jens
- Abstract
Background: White matter lesions (WMLs) on brain magnetic resonance imaging (MRI) in multiple sclerosis (MS) may contribute to misdiagnosis. In chronic active lesions, peripheral iron-laden macrophages appear as paramagnetic rim lesions (PRLs). Objective: To evaluate the sensitivity and specificity of PRLs in differentiating MS from mimics using clinical 3T MRI scanners. Method: This retrospective international study reviewed MRI scans of patients with MS (n = 254), MS mimics (n = 91) and older healthy controls (n = 217). WMLs, detected using fluid-attenuated inversion recovery MRI, were analysed with phase-sensitive imaging. Sensitivity and specificity were assessed for PRLs. Results: At least one PRL was found in 22.9% of MS and 26.1% of clinically isolated syndrome (CIS) patients. Only one PRL was found elsewhere. The identification of ⩾1 PRL was the optimal cut-off and had high specificity (99.7%, confidence interval (CI) = 98.20%–99.99%) when distinguishing MS and CIS from mimics and healthy controls, but lower sensitivity (24.0%, CI = 18.9%–36.6%). All patients with a PRL showing a central vein sign (CVS) in the same lesion (n = 54) had MS or CIS, giving a specificity of 100% (CI = 98.8%–100.0%) but equally low sensitivity (21.3%, CI = 16.4%–26.81%) Conclusion: PRLs may reduce diagnostic uncertainty in MS by being a highly specific imaging diagnostic biomarker, especially when used in conjunction with the CVS.
- Subjects
DIAGNOSTIC imaging; MULTIPLE sclerosis; MAGNETIC resonance imaging; BIOMARKERS; WHITE matter (Nerve tissue)
- Publication
Multiple Sclerosis Journal, 2022, Vol 28, Issue 14, p2212
- ISSN
1352-4585
- Publication type
Article
- DOI
10.1177/13524585221118677