Iron Rims as an Imaging Biomarker in MS: A Systematic Mapping Review

Altokhis, Amjad; Alotaibi, Abdulmajeed; Felmban, Ghadah; Constantinescu, Cris S.; Evangelou, Nikos

doi:10.3390/diagnostics10110968

Cited by 17 publications

(24 citation statements)

References 67 publications

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“…Examining periventricular lesions of similar size revealed a high degree of correlation between reduction of the rate of lesion expansion and increasing distance from CSF, while grouped analysis of individual lesions demonstrated a significantly higher proportion of expanding lesions in close proximity to the ventricles compared to the deep white matter. While earlier work has indicated that the anatomical distribution of expanding lesions follows the common periventricular pattern of lesion distribution in MS, 2,16 this study is the first to demonstrate a direct relationship between the degree of chronic lesion expansion and the distance from the ventricular border, highlighting CSF-related dependency of the chronic inflammatory process. Providing that lesion expansion is an imaging equivalent of slow-burning inflammation at the lesion rim, our results suggest that inflammatory activity at the rim of chronic lesions is also dependent on the distance from CSF.…”

Section: Discussionmentioning

confidence: 41%

The expansion and severity of chronic MS lesions follows a periventricular gradient

Klistorner

Barnett

Graham

et al. 2021

Preprint

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Background and Objectives: Expansion of chronic lesions in MS patients and recently described CSF-related gradient of tissue damage are linked to microglial activation. The aim of the current study was to investigate whether lesion expansion is associated with proximity to ventricular CSF spaces. Methods: Pre- and post-gadolinium 3D-T1, 3D FLAIR and diffusion tensor images were acquired from 36 RRMS patients. Lesional activity was analysed between baseline and 48 months at different distances from the CSF using successive 1-mm thick concentric rings radiating from the ventricles. Results: Voxel-based analysis of the rate of lesion expansion demonstrated a clear periventricular gradient decreasing away from the ventricles. This was particularly apparent when lesions of equal diameter were analysed. Periventricular lesional tissue showed higher degree of tissue distraction at baseline that significantly increased during follow-up in rings close to CSF. This longitudinal change was proportional to degree of lesion expansion. Lesion-wise analysis revealed a gradual, centrifugal decrease in the proportion of expanding lesions from the immediate periventricular zone. Discussion: Our data suggest that chronic white matter lesions in close proximity to the ventricles are more destructive, show a higher degree of expansion at the lesion border and accelerated tissue loss in the lesion core.

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Section: Discussionmentioning

confidence: 41%

The expansion and severity of chronic MS lesions follows a periventricular gradient

Klistorner

Barnett

Graham

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…26,27 However, there are reservations on the clinical utility as PRLs are only seen in a minority of WMLs. 13,28 This retrospective international, multicentre study within the Magnetic Resonance Imaging in MS (MAGNIMS) Study Group aimed to test the potential for PRLs in clinical practice. MRIs for patients with MS and MS mimics (including cerebral small vessel disease, migraine and NMOSD) were compared.…”

Section: Paramagnetic Rims Are a Promising Diagnostic Imaging Biomark...mentioning

confidence: 99%

Paramagnetic rims are a promising diagnostic imaging biomarker in multiple sclerosis

et al. 2022

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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.

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“…Examining periventricular lesions of similar size revealed a high degree of correlation between reduction of the rate of lesion expansion and increasing distance from CSF, while grouped analysis of individual lesions demonstrated a significantly higher proportion of expanding lesions in close proximity to the ventricles compared to the deep WM. While earlier work has indicated that the anatomical distribution of expanding lesions follows the common periventricular pattern of lesion distribution in MS, 2,18 this study is the first to demonstrate a direct relationship between the degree of chronic lesion expansion and the distance from the ventricular border, highlighting CSFrelated dependency of the chronic inflammatory process. Providing that lesion expansion is an imaging equivalent of slow-burning inflammation at the lesion rim, our results suggest that inflammatory activity at the rim of chronic lesions is also dependent on the distance from CSF.…”

Section: Periventricular Gradient Of Expansion and Severity In Chroni...mentioning

confidence: 42%

The expansion and severity of chronic MS lesions follows a periventricular gradient

et al. 2022

View full text Add to dashboard Cite

Background and Objectives: Expansion of chronic lesions in multiple sclerosis (MS) patients and recently described cerebrospinal fluid (CSF)-related gradient of tissue damage are linked to microglial activation. The aim of this study was to investigate whether lesion expansion is associated with proximity to ventricular CSF spaces. Methods: Pre- and post-gadolinium three-dimensional (3D)-T1, 3D FLAIR and diffusion tensor images were acquired from 36 relapsing-remitting MS (RRMS) patients. Lesional activity was analysed between baseline and 48 months at different distances from the CSF using successive 1 mm thick concentric bands radiating from the ventricles. Results: Voxel-based analysis of the rate of lesion expansion demonstrated a clear periventricular gradient decreasing away from the ventricles. This was particularly apparent when lesions of equal diameter were analysed. Periventricular lesional tissue showed higher degree of tissue destruction at baseline that significantly increased during follow-up in bands close to CSF. This longitudinal change was proportional to degree of lesion expansion. Lesion-wise analysis revealed a gradual, centrifugal decrease in the proportion of expanding lesions from the immediate periventricular zone. Discussion: Our data suggest that chronic white matter lesions in close proximity to the ventricles are more destructive, show a higher degree of expansion at the lesion border and accelerated tissue loss in the lesion core.

show abstract

Iron Rims as an Imaging Biomarker in MS: A Systematic Mapping Review

Cited by 17 publications

References 67 publications

The expansion and severity of chronic MS lesions follows a periventricular gradient

The expansion and severity of chronic MS lesions follows a periventricular gradient

Paramagnetic rims are a promising diagnostic imaging biomarker in multiple sclerosis

The expansion and severity of chronic MS lesions follows a periventricular gradient

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