Paramagnetic rims are a promising diagnostic imaging biomarker in multiple sclerosis

Author:

Meaton Isobel1,Altokhis Amjad1,Allen Christopher Martin1,Clarke Margareta A2ORCID,Sinnecker Tim3,Meier Dominik3,Enzinger Christian4,Calabrese Massimiliano5,De Stefano Nicola6ORCID,Pitiot Alain7ORCID,Giorgio Antonio6,Schoonheim Menno M8,Paul Friedemann9,Pawlak Mikolaj A10ORCID,Schmidt Reinhold4,Granziera Cristina11ORCID,Kappos Ludwig11ORCID,Montalban Xavier12,Rovira Àlex13ORCID,Wuerfel Jens14,Evangelou Nikos1

Affiliation:

1. Mental Health and Clinical Neurosciences Academic Unit, School of Medicine, University of Nottingham, Nottingham, UK

2. Institute of Imaging Science, Vanderbilt University Medical Center, Vanderbilt University, Nashville, TN, USA

3. Medical Image Analysis Center AG and Department of Biomedical Engineering, University Basel, Basel, Switzerland

4. Department of Neurology, Medical University of Graz, Graz, Austria

5. Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy

6. Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy

7. Laboratory of Image and Data Analysis, Ilixa Ltd, London, UK

8. Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands

9. Neurocure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany

10. Department of Neurology and Cerebrovascular Disorders, Poznan University of Medical Sciences, Poznan, Poland

11. Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital, University of Basel, Basel, Switzerland

12. Centre d’Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain

13. Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

14. Medical Image Analysis Center AG and Department of Biomedical Engineering, University Basel, Basel, Switzerland/Neurocure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany

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.

Publisher

SAGE Publications

Subject

Neurology (clinical),Neurology

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