Tang Yang, Wang Huajiao, Wang Xiaohua, Yan Zichun, Zhu Qiyuan, Yin Ting, Xu Yuhui, Wei Yiqiu, Yang Bin, Shi Zhuowei, Li Yongmei
Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
MR Research Collaborations, Siemens Healthineers Ltd, Chengdu 610000, China.
J Neuroimmunol. 2025 Nov 15;408:578738. doi: 10.1016/j.jneuroim.2025.578738. Epub 2025 Aug 28.
Paramagnetic rim lesions (PRLs), identified using susceptibility-sensitive sequences, are established prognostic imaging markers for multiple sclerosis (MS). However, susceptibility-sensitive sequences are not yet routinely performed in many clinical centers. We aim to investigate an imaging feature observed on conventional T2 fluid-attenuated inversion recovery (FLAIR) sequences, termed "FLAIR hyper-rim", and explore its association with PRLs. This study included 61 relapsing-remitting MS (RRMS) and 35 healthy controls. Based on the presence or absence of paramagnetic rim in susceptibility-sensitive images (PRL+/-) and FLAIR hyper-rim sign in T2-FLAIR images (Rim+/-), white matter (WM) lesions were classified into four subgroups: (1) PRL + Rim+; (2) PRL + Rim-; (3) PRL-Rim+; (4) PRL-Rim-. Differences in lesion volume and microstructural damage were compared, based on diffusion kurtosis imaging (DKI) parameters, including kurtosis fractional anisotropy (KFA), mean kurtosis (MK), axial kurtosis (AK), and radial kurtosis (RK). The correlations between lesion load and clinical scale scores and brain volume were further investigated. 1109 WM lesions were analyzed, including 338 PRLs and 300 FLAIR hyper-rim lesions. Of 300 FLAIR hyper-rim lesions, 197 (65.7 %) co-localized with a PRL, and 197/338 (58.3 %) PRLs co-localized with a FLAIR hyper-rim lesion. Considering the chance-level overlap, we further calculated the Jaccard index (44.7 %, 95 % CI: 39.8-49.5), and Cohen's kappa (κ = 0.463, 95 % CI: 0.408-0.518), both indicating a moderate association. The PRL + Rim+ group exhibited the lowest AK and RK values, significantly different from those of other three groups (all P < 0.05). Additionally, the PRL-Rim+ group exhibited lower MK, AK and RK values compared to the PRL-Rim- group (all P < 0.05). Furthermore, FLAIR hyper-rim lesions were negatively related to cognitive test and brain volume. FLAIR hyper-rim lesions appear to represent a subtype of MS lesions characterized by more severe tissue damage and may help identify lesions more likely to be PRLs, although their predictive value requires further validation.
使用敏感性序列识别出的顺磁性边缘病变（PRLs）是多发性硬化症（MS）公认的预后成像标志物。然而，许多临床中心尚未常规进行敏感性序列检查。我们旨在研究在常规T2液体衰减反转恢复（FLAIR）序列上观察到的一种成像特征，即“FLAIR高信号边缘”，并探讨其与PRLs的关联。本研究纳入了61例复发缓解型MS（RRMS）患者和35名健康对照者。根据敏感性图像中是否存在顺磁性边缘（PRL+/-）以及T2-FLAIR图像中是否存在FLAIR高信号边缘征象（边缘+/-），将白质（WM）病变分为四个亚组：（1）PRL + 边缘+；（2）PRL + 边缘-；（3）PRL-边缘+；（4）PRL-边缘-。基于扩散峰度成像（DKI）参数，包括峰度分数各向异性（KFA）、平均峰度（MK）、轴向峰度（AK）和径向峰度（RK），比较病变体积和微观结构损伤的差异。进一步研究病变负荷与临床量表评分及脑容量之间的相关性。共分析了1109个WM病变，包括338个PRLs和300个FLAIR高信号边缘病变。在300个FLAIR高信号边缘病变中，197个（65.7%）与PRL共定位，197/338（58.3%）个PRLs与FLAIR高信号边缘病变共定位。考虑到随机重叠概率，我们进一步计算了杰卡德指数（44.7%，95%CI：39.8-49.5）和科恩kappa系数（κ = 0.463，95%CI：0.408-0.518），两者均表明存在中度关联。PRL + 边缘+组的AK和RK值最低，与其他三组有显著差异（均P < 0.05）。此外，与PRL-边缘-组相比，PRL-边缘+组的MK、AK和RK值较低（均P < 0.05）。此外，FLAIR高信号边缘病变与认知测试和脑容量呈负相关。FLAIR高信号边缘病变似乎代表了一种MS病变亚型，其特征是组织损伤更严重，可能有助于识别更有可能是PRLs的病变，尽管其预测价值需要进一步验证。
