The presence of a paramagnetic phase rim in multiple sclerosis is linked to lesion age: an exploratory study

Klistorner, Samuel; Usnich, Tatiana; Clarke, Margareta A.; Pareto, Deborah; Rovira, Àlex; Paul, Friedemann; Barnett, Michael; Klistorner, Alexander

The presence of a paramagnetic phase rim in multiple sclerosis is linked to lesion age: an exploratory study

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Item Type:	Article
Title:	The presence of a paramagnetic phase rim in multiple sclerosis is linked to lesion age: an exploratory study
Creators Name:	Klistorner, Samuel, Usnich, Tatiana, Clarke, Margareta A., Pareto, Deborah, Rovira, Àlex, Paul, Friedemann, Barnett, Michael and Klistorner, Alexander
Abstract:	BACKGROUND: In relapsing-remitting multiple sclerosis (RRMS), smouldering inflammation at the rims of chronic active lesions is increasingly recognised as a key driver of disease progression. Paramagnetic rim lesions (PRLs), detected using susceptibility-weighted imaging, have emerged as a potential biomarker of this chronic inflammatory activity. However, their clinical relevance and relationship to lesion-specific features such as size and age remain poorly understood. OBJECTIVE: To investigate the association between PRL presence and clinical/radiological measures of disease progression, and to explore how PRLs relate to lesion size and age. METHODS: A retrospective study of 60 RRMS patients with over 5 years of magnetic resonance imaging data was conducted using susceptibility-weighted angiography. Lesions larger than 100 mm(3) were analysed. RESULTS: PRLs were present in 48% of patients and represented 13% of lesions. PRLs were significantly larger and more structurally damaged, with volume correlating with EDSS change and brain atrophy. All lesions formed within 5 years of imaging were PRLs. This finding was validated in two independent international cohorts. Moreover, the proportion of rim-positive lesions decreased as lesion age increased. CONCLUSION: PRLs are closely linked to lesion age and early development, supporting their role as a dynamic biomarker of lesion activity in multiple sclerosis.
Keywords:	Chronic Active Lesions, Magnetic Resonance Imaging Biomarkers, Lesion Evolution, Iron Deposition, Susceptibility-Weighted Images, Rim Lesions
Source:	Multiple Sclerosis Journal Experimental Translational and Clinical
ISSN:	2055-2173
Publisher:	Sage Publications
Volume:	11
Number:	3
Page Range:	1-11
Date:	September 2025
Official Publication:	https://doi.org/10.1177/20552173251378788
PubMed:	View item in PubMed

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