Frequency and Diagnostic Implications of Paramagnetic Rim Lesions in People Presenting for Diagnosis to a Multiple Sclerosis Clinic

作者：Brian Renner, Elizabeth Verter, Martina Absinta, Lynn Daboul, Praneeta Raza, Melissa L. Martin, Quy Cao, Carly M. O’Donnell, Paulo Rodrigues, Marc Ramos, Vesna Prchkovska, J. Andrew Derbyshire, Christina Azevedo, Amit Bar‐Or, Eduardo Caverzasi, Peter A. Calabresi, Bruce Cree, Léorah Freeman, Roland G. Henry, Erin E. Longbrake, Jiwon Oh, Nico Papinutto, Daniel Pelletier, Rohini Samudralwar, Matthew K. Schindler, Elias S. Sotirchos, Nancy L. Sicotte, Andrew Solomon, Russell T. Shinohara, Daniel S. Reich, Daniel Ontaneda, Pascal Sati · 发表于：Neurology · 年份：2025 · DOI：10.1212/wnl.0000000000213912 · 被引用次数：6 · 研究领域：Multiple Sclerosis Research Studies、Cutaneous Melanoma Detection and Management、Polyomavirus and related diseases

BACKGROUND AND OBJECTIVES: Paramagnetic rim lesions (PRLs) are a well-established imaging biomarker of chronic active multiple sclerosis (MS) lesions. PRLs have been shown to be highly specific for MS (∼90% specificity), and their prevalence has been estimated to be approximately 50% in patients with clinically established diagnoses of MS. In this study, we evaluated the frequency and diagnostic value of PRLs in patients at first clinical presentation. METHODS: Adults age 18-64 years presenting with clinical symptoms or radiologic suspicion of demyelinating disease referred to academic specialty MS centers without a definitive diagnosis were prospectively enrolled in a multicenter, cross-sectional, observational study. Phase images from high-resolution 3D echo-planar imaging were acquired on 3-tesla brain MRI and evaluated for PRLs by 3 independent raters, blinded to diagnosis, with adjudication from a fourth expert rater. Diagnostic performance of PRLs for a diagnosis of MS using the 2017 McDonald criteria as gold standard was evaluated using diagnostic thresholds based on the presence of at least 1 PRL (≥1 PRL) or at least 2 PRLs (≥2 PRLs). RESULTS: = 0.03). DISCUSSION: PRLs are highly prevalent early in patients with MS at the time of first clinical presentation and can differentiate MS from mimics with high accuracy.