Elkady Ahmed M, Elliott Colm, Fetco Dumitru, Araujo David, Karimaghaloo Zahra, Ganzetti Marco, Clayton David, Craveiro Licinio, Kazlauskaite Agne, Narayanan Sridar, Arnold Douglas L, Rudko David A
McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, Montreal, Quebec, Canada.
Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada.
J Magn Reson Imaging. 2025 Apr;61(4):1812-1828. doi: 10.1002/jmri.29583. Epub 2024 Sep 6.
Multiple sclerosis (MS) paramagnetic rim lesions (PRLs) are markers of chronic active biology and exhibit complex iron and myelin changes that may complicate quantification when using conventional MRI approaches.
To conduct a multiparametric MRI analysis of PRLs.
Retrospective/longitudinal.
Ninety-five progressive MS subjects with at least one persistent PRL who were enrolled in the CONSONANCE trial.
FIELD STRENGTH/SEQUENCE: 3-T/Susceptibility-weighted, T1-weighted, T2-weighted, and fluid-attenuated inversion recovery.
Acute/chronic PRLs and non-PRLs were measured at screening, 24, 48, and 96 weeks using quantitative magnetic susceptibility (QS), R2*, and standardized T1w/T2w ratio (sT1w/T2w). PRL analyses were performed for whole lesion, core, and rim. The correlations between PRL core and rim sT1w/T2w, QS, and R2* were assessed.
Linear mixed models. A P-value <0.05 was considered significant.
There was a significant decrease in sT1w/T2w (-0.24 ± -5.3 × 10) and R2* (-3.6 ± 2.2 Hz) but a significant increase in QS (+21 ± 1.3 ppb) using whole-lesion analysis of chronic PRLs compared to non-PRLs at screening. Tissue damage accumulated at the 96-week time point was more evident in acute/chronic PRLs compared to acute/chronic non-PRLs (ΔsT1w/T2w = -0.21/-0.24 ± 0.033/0.0053; ΔR2* = -4.4/-3.6 ± 1.4/2.2 Hz). New, acute PRL sT1w/T2w significantly increased in lesion core (+4.3 × 10 ± 1.2 × 10) and rim (+5.6 × 10 ± 1.2 × 10) 24 weeks post lesion inception, suggestive of partial recovery. Chronic PRLs, contrastingly, showed significant decreases in sT1w/T2w over the initial 24 weeks for both core (-2.1 × 10 ± 2.0 × 10) and rim (-2.4 × 10 ± 2.0 × 10), indicative of irreversible tissue damage. Significant positive correlations between PRL core and rim sT1w/T2w (R = 0.53), R2* (R = 0.69) and QS (R = 0.52) were observed.
Multiparametric assessment of PRLs has the potential to be a valuable tool for assessing complex iron and myelin changes in chronic active PRLs of progressive MS patients.
2 TECHNICAL EFFICACY: Stage 3.
多发性硬化症（MS）的顺磁性边缘病变（PRL）是慢性活动性生物学的标志物，表现出复杂的铁和髓鞘变化，这可能会使使用传统MRI方法进行量化变得复杂。
对PRL进行多参数MRI分析。
回顾性/纵向研究。
95名患有至少一个持续性PRL的进展型MS患者，他们参与了CONSONANCE试验。
场强/序列：3-T/ susceptibility加权成像、T1加权成像、T2加权成像和液体衰减反转恢复序列。
在筛查时、24周、48周和96周使用定量磁化率（QS）、R2和标准化T1w/T2w比值（sT1w/T2w）测量急性/慢性PRL和非PRL。对整个病变、核心和边缘进行PRL分析。评估PRL核心与边缘的sT1w/T2w、QS和R2之间的相关性。
线性混合模型。P值<0.05被认为具有统计学意义。
与筛查时的非PRL相比，使用慢性PRL的全病变分析显示sT1w/T2w（-0.24±-5.3×10）和R2*（-3.6±2.2Hz）显著降低，但QS（+21±1.3ppb）显著升高。与急性/慢性非PRL相比，在96周时间点累积的组织损伤在急性/慢性PRL中更明显（ΔsT1w/T2w=-0.21/-0.24±0.033/0.0053；ΔR2*=--4.4/-3.6±1.4/2.2Hz）。新的急性PRL的sT1w/T2w在病变发生后24周时在病变核心（+4.3×10±1.2×10）和边缘（+5.6×10±1.2×10）显著增加，提示部分恢复。相比之下，慢性PRL在最初24周内核心（-2.1×10±2.0×10）和边缘（-2.4×10±2.0×10）的sT1w/T2w均显著降低，表明存在不可逆的组织损伤。观察到PRL核心与边缘的sT1w/T2w（R=0.53）、R2*（R=0.69）和QS（R=0.52）之间存在显著正相关。
对PRL进行多参数评估有可能成为评估进展型MS患者慢性活动性PRL中复杂铁和髓鞘变化的有价值工具。
2 技术效能：3级
