Paramagnetic rims are a promising diagnostic imaging biomarker in multiple sclerosis

Isobel Meaton, Amjad Altokhis, Christopher Martin Allen, Margareta A. Clarke, Tim Sinnecker, Dominik Meier, Christian Enzinger, Massimiliano Calabrese, Nicola De Stefano, Alain Pitiot, Antonio Giorgio, Menno M. Schoonheim, Friedemann Paul, Mikolaj A. Pawlak, Reinhold Schmidt, Cristina Granziera, Ludwig Kappos, Xavier Montalban, Àlex Rovira, Jens WuerfelNikos Evangelou*

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

2 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)2212-2220
Number of pages9
JournalMultiple Sclerosis Journal
Issue number14
Publication statusPublished - Dec 2022


  • CIS
  • MRI
  • Multiple sclerosis
  • biomarkers


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