Prognostic significance of paramagnetic rim lesions in multiple sclerosis: A systematic review

Adon Toru Asahina; Joe Lu; Pooja Chugh; Srishti Sharma; Prakriti Sharma; Sheryn Tan; Joshua Kovoor; Brandon Stretton; Aashray Gupta; Annabel Sorby-Adams; Rudy Goh; Adil Harroud; Margareta A Clarke; Nikos Evangelou; Sandy Patel; Andrew Dwyer; Marc Agzarian; Stephen Bacchi; Mark Slee

doi:10.1016/j.jocn.2024.110810

Prognostic significance of paramagnetic rim lesions in multiple sclerosis: A systematic review

J Clin Neurosci. 2024 Nov:129:110810. doi: 10.1016/j.jocn.2024.110810. Epub 2024 Sep 3.

Authors

Adon Toru Asahina¹, Joe Lu², Pooja Chugh³, Srishti Sharma³, Prakriti Sharma³, Sheryn Tan⁴, Joshua Kovoor⁵, Brandon Stretton⁵, Aashray Gupta⁶, Annabel Sorby-Adams⁷, Rudy Goh⁸, Adil Harroud⁹, Margareta A Clarke¹⁰, Nikos Evangelou¹⁰, Sandy Patel¹¹, Andrew Dwyer¹², Marc Agzarian¹³, Stephen Bacchi¹⁴, Mark Slee³

Affiliations

¹ Flinders Medical Centre, Bedford Park, SA 5042, Australia; South Australia Medical Imaging, Adelaide, SA 5000, Australia; Royal Adelaide Hospital, Adelaide, SA 5000, Australia; Queen Elizabeth Hospital, Woodville, SA 5011, Australia. Electronic address: toru.asahina@sa.gov.au.
² Flinders Medical Centre, Bedford Park, SA 5042, Australia; University of Adelaide, Adelaide, SA 5005, Australia; Royal Adelaide Hospital, Adelaide, SA 5000, Australia.
³ College of Medicine and Public Health, Flinders University of South Australia, SA 5042, Australia.
⁴ University of Adelaide, Adelaide, SA 5005, Australia.
⁵ University of Adelaide, Adelaide, SA 5005, Australia; Royal Adelaide Hospital, Adelaide, SA 5000, Australia; Queen Elizabeth Hospital, Woodville, SA 5011, Australia.
⁶ University of Adelaide, Adelaide, SA 5005, Australia; Gold Coast University Hospital, Southport, QLD 4215, Australia.
⁷ University of Adelaide, Adelaide, SA 5005, Australia; Department of Neurology and the Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02138, USA.
⁸ University of Adelaide, Adelaide, SA 5005, Australia; Royal Adelaide Hospital, Adelaide, SA 5000, Australia; Lyell McEwin Hospital, Elizabeth Vale, SA 5112, Australia.
⁹ McGill University, Montreal, Quebec H3A 0G4, Canada.
¹⁰ Mental Health and Clinical Neurosciences Academic Unit, School of Medicine, University of Nottingham, Nottingham, UK.
¹¹ South Australia Medical Imaging, Adelaide, SA 5000, Australia.
¹² College of Medicine and Public Health, Flinders University of South Australia, SA 5042, Australia; South Australia Medical Imaging, Adelaide, SA 5000, Australia; South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia.
¹³ College of Medicine and Public Health, Flinders University of South Australia, SA 5042, Australia; South Australia Medical Imaging, Adelaide, SA 5000, Australia.
¹⁴ Flinders Medical Centre, Bedford Park, SA 5042, Australia; College of Medicine and Public Health, Flinders University of South Australia, SA 5042, Australia; Royal Adelaide Hospital, Adelaide, SA 5000, Australia; Department of Neurology and the Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02138, USA.

PMID: 39232367
DOI: 10.1016/j.jocn.2024.110810

Abstract

The diagnostic potential of paramagnetic rim lesions (PRLs) has been previously established; however, the prognostic significance of these lesions has not previously been consistently described. This study aimed to establish the prognostic role of PRLs in MS with respect to the Expanded Disability Status Scale (EDSS) and rates of disability progression. Databases of PubMed, EMBASE, Scopus and reference lists of selected articles were searched up to 29/04/2023. The review was conducted in accordance with PRISMA guidelines and was registered prospectively on PROSPERO (CRD42023422052). 7 studies were included in the final review. All of the eligible studies found that patients with PRLs tend to have higher baseline EDSS scores. Longitudinal assessments revealed greater EDSS progression in patients with PRLs over time in most studies. However, the effect of location of PRLs within the central nervous system were not assessed across the studies. Only one study investigated progression independent of relapse activity (PIRA) and showed that this clinical entity occurred in a greater proportion in patients with PRLs. This review supports PRLs as a predictor of EDSS progression. This measure has widespread applicability, however further multicentre studies are needed. Future research should explore the impact of PRLs on silent disability, PIRA, take into account different MS phenotypes and the topography of PRLs in prognosis.

Keywords: Prognostication; Progression independent of relapse activity; Radiology; Susceptibility-weighted imaging.

Publication types

Systematic Review
Review

MeSH terms

Disease Progression*
Humans
Magnetic Resonance Imaging
Multiple Sclerosis* / diagnosis
Multiple Sclerosis* / diagnostic imaging
Multiple Sclerosis* / pathology
Multiple Sclerosis* / physiopathology
Prognosis