Paramagnetic Rim Lesions are Specific to Multiple Sclerosis: An International Multicenter 3T MRI Study

Maggi, Pietro; Sati, Pascal; Nair, Govind; Cortese, Irene; Jacobson, Steven; Smith, Bryan; Nath, Avindra; Ohayon, Joan; Pesch, Vincent Van; Perrotta, Gaetano; Pot, Caroline; Théaudin, Marie; Martinelli, Vittorio; Scotti, Roberta; Wu, Tianxia; Pasquier, Renaud Du; Calabresi, Peter A.; Filippi, Massimo; Reich, Daniel S.; Absinta, Martina

doi:10.1002/ana.25877

Cited by 119 publications

(106 citation statements)

References 44 publications

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“…We emailed 14 study investigators to request additional study data or to seek clarification about study methodology, and 7 kindly replied. Not captured by our search were 5 studies that post-dated our literature search [ 20 , 29 – 32 ]. These were subsequently included in our sensitivity analyses.…”

Section: Resultsmentioning

confidence: 99%

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The prevalence of paramagnetic rim lesions in multiple sclerosis: A systematic review and meta-analysis

et al. 2021

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Background Recent findings from several studies have shown that paramagnetic rim lesions identified using susceptibility-based MRI could represent potential diagnostic and prognostic biomarkers in multiple sclerosis (MS). Here, we perform a systematic review and meta-analysis of the existing literature to assess their pooled prevalence at lesion-level and patient-level. Methods Both database searching (PubMed and Embase) and handsearching were conducted to identify studies allowing the lesion-level and/or patient-level prevalence of rim lesions or chronic active lesions to be calculated. Pooled prevalence was estimated using the DerSimonian-Laird random-effects model. Subgroup analysis and meta-regression were performed to explore possible sources of heterogeneity. PROSPERO registration: CRD42020192282. Results 29 studies comprising 1230 patients were eligible for analysis. Meta-analysis estimated pooled prevalences of 9.8% (95% CI: 6.6–14.2) and 40.6% (95% CI: 26.2–56.8) for rim lesions at lesion-level and patient-level, respectively. Pooled lesion-level and patient-level prevalences for chronic active lesions were 12.0% (95% CI: 9.0–15.8) and 64.8% (95% CI: 54.3–74.0), respectively. Considerable heterogeneity was observed across studies (I2>75%). Subgroup analysis revealed a significant difference in patient-level prevalence between studies conducted at 3T and 7T (p = 0.0312). Meta-regression analyses also showed significant differences in lesion-level prevalence with respect to age (p = 0.0018, R2 = 0.20) and disease duration (p = 0.0018, R2 = 0.48). Other moderator analyses demonstrated no significant differences according to MRI sequence, gender and expanded disability status scale (EDSS). Conclusion In this study, we show that paramagnetic rim lesions may be present in an important proportion of MS patients, notwithstanding significant variation in their assessment across studies. In view of their possible clinical relevance, we believe that clear guidelines should be introduced to standardise their assessment across research centres to in turn facilitate future analyses.

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Section: Resultsmentioning

confidence: 99%

“…In addition to paramagnetic rims, susceptibility-based MRI has also revealed central veins within white matter lesions; both features appear to be highly specific to MS, and have therefore been proposed as possible diagnostic markers [ 18 – 20 ].…”

Section: Introductionmentioning

confidence: 99%

The prevalence of paramagnetic rim lesions in multiple sclerosis: A systematic review and meta-analysis

et al. 2021

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“…It has been demonstrated that only a minority of NMOSD brain lesions were neighboured (and not centred) by a vein (35%) and hypointense rings surrounding lesions were very rarely detectable (2%) [71]. The use of susceptibility-weighted imaging-filtered phase images has further allowed to characterise lesion morphology both in MS and NMOSD, confirming that in the latter a paramagnetic phase change, in rim-like or nodular fashion, is virtually absent compared to MS (2%) [72]. Interestingly, a reduced periventricular venous density has been demonstrated in MS but not in NMOSD, showing that the reduced proportion of lesion containing a venule is not attributable to a minor venous representation in the latter [73].…”

Section: Lesion Characterisation In Nmosdmentioning

confidence: 90%

“…7-T MRI has the potential to differentiate these two conditions based on a more accurate lesion morphology. Indeed, lesions in Susac syndrome are not venule-centred and do not present a hypointense ring on T2*-weighted images [72]. Moreover, in Susac syndrome, calossal lesions are hyperintense in the centre and surrounded by a ring-like signal extinction on 7-T T2-weighted images and are more hypointense than MS lesions, reflecting a greater tissue degradation [79].…”

Section: Lesion Characterisation In Nmosdmentioning

confidence: 99%

Ultra-high-field 7-T MRI in multiple sclerosis and other demyelinating diseases: from pathology to clinical practice

2020

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Magnetic resonance imaging (MRI) is essential for the early diagnosis of multiple sclerosis (MS), for investigating the disease pathophysiology, and for discriminating MS from other neurological diseases. Ultra-high-field strength (7-T) MRI provides a new tool for studying MS and other demyelinating diseases both in research and in clinical settings. We present an overview of 7-T MRI application in MS focusing on increased sensitivity and specificity for lesion detection and characterisation in the brain and spinal cord, central vein sign identification, and leptomeningeal enhancement detection. We also discuss the role of 7-T MRI in improving our understanding of MS pathophysiology with the aid of metabolic imaging. In addition, we present 7-T MRI applications in other demyelinating diseases. 7-T MRI allows better detection of the anatomical, pathological, and functional features of MS, thus improving our understanding of MS pathology in vivo. 7-T MRI also represents a potential tool for earlier and more accurate diagnosis.

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“…Recent advances in MRI techniques may help to discriminate between those demyelinating diseases. The utility of the central vein sign in MS and the paramagnetic rim sign in chronic active MS are helpful, but they are not yet widely applied in clinical practice 50‐51 …”

Section: Brain Lesions and Their Magnetic Resonance Imaging Findingsmentioning

confidence: 99%

Clinical and radiological features of MS, NMOSD, and MOGAD, and evolution of the diagnostic processes in Thailand

Rattanathamsakul

Siritho

2021

Neurology & Clinical Neurosc

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Thailand and other Asian countries have experienced an increase in the prevalence of multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). 1 This is probably due to both the increasing disease awareness and accessibility to diagnostic serological testing and magnetic resonance imaging (MRI). Although MS, NMOSD, and MOGAD have distinct mechanisms, prognoses, and treatments, they share common clinical features or even mimic other conditions. It is not uncommon for the diagnostician to be unconfident to make a definite diagnosis at the first presentation, especially with the lack of the typical presentations, MRI findings, and positive serological markers. Moreover, other mimic diseases in Asia, which are somewhat different from Western countries, also need excluding. Herein, we summarize the typical presentations of MS, NMOSD, and MOGAD along with the evolution and obstacles in diagnosing these diseases in Thailand. We also highlight the essential practical points to discriminate between them. | UTILIZING THE D IAG NOS TI C CRITERIA OF MS , NMOS D, AND MOG ADThe diagnostic criteria for both MS and NMOSD have been revised many times as our understanding of the diseases has improved.Revised criteria have enabled earlier diagnosis, provided prompt treatment, and potentially prevented future disability. However, MS and NMOSD are only diagnosed if the current criteria are met, and alternative diagnoses are excluded. A significant milestone in improving diagnosis was the 2001McDonald criteria incorporating MRI findings to serve as surrogates

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Paramagnetic Rim Lesions are Specific to Multiple Sclerosis: An International Multicenter 3T MRI Study

Cited by 119 publications

References 44 publications

The prevalence of paramagnetic rim lesions in multiple sclerosis: A systematic review and meta-analysis

The prevalence of paramagnetic rim lesions in multiple sclerosis: A systematic review and meta-analysis

Ultra-high-field 7-T MRI in multiple sclerosis and other demyelinating diseases: from pathology to clinical practice

Clinical and radiological features of MS, NMOSD, and MOGAD, and evolution of the diagnostic processes in Thailand

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