Longitudinal Multiparametric Quantitative MRI Evaluation of Acute and Chronic Multiple Sclerosis Paramagnetic Rim Lesions

Overview

Journal J Magn Reson Imaging

Date 2024 Sep 6

PMID 39239775

Authors

Ahmed M Elkady

Colm Elliott

Dumitru Fetco

David Araujo

Zahra Karimaghaloo

Marco Ganzetti

David Clayton

Licinio Craveiro

Agne Kazlauskaite

Sridar Narayanan

Douglas L Arnold

David A Rudko

Affiliations

Soon will be listed here.

Abstract

Background: 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.

Purpose: To conduct a multiparametric MRI analysis of PRLs.

Study Type: Retrospective/longitudinal.

Subjects: 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.

Assessment: 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.

Statistical Tests: Linear mixed models. A P-value <0.05 was considered significant.

Results: 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.

Data Conclusion: 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.

Level Of Evidence: 2 TECHNICAL EFFICACY: Stage 3.

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