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Longitudinal clinical study of patients with iron rim lesions in multiple sclerosis

Altokhis AI 1 , Hibbert AM 2 , Allen CM 3 , Mougin O 4 , Alotaibi A 5 , Lim SY 6 Show all authors , Constantinescu CS 7 , Abdel-Fahim R 2 , Evangelou N 3

Affiliations 

  • 1 Mental Health and Clinical Neuroscience Academic Unit, University of Nottingham, Nottingham, UK/Department of Neurology, Nottingham University Hospital NHS Trust, Nottingham, UK/Division of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, SA
  • 2 Department of Neurology, Nottingham University Hospital NHS Trust, Nottingham, UK
  • 3 Mental Health and Clinical Neuroscience Academic Unit, University of Nottingham, Nottingham, UK/Department of Neurology, Nottingham University Hospital NHS Trust, Nottingham, UK
  • 4 Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK
  • 5 Mental Health and Clinical Neuroscience Academic Unit, University of Nottingham, Nottingham, UK/Department of Neurology, Nottingham University Hospital NHS Trust, Nottingham, UK/Department of Radiological Sciences, School of Applied Medical Sciences, King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia/Radiology and Neurosciences unit, King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
  • 6 Mental Health and Clinical Neuroscience Academic Unit, University of Nottingham, Nottingham, UK/School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Malaysia
  • 7 Department of Neurology, Cooper Neurological Institute, Camden, NJ, USA
Mult Scler, 2022 Dec;28(14):2202-2211.
PMID: 36000485 DOI: 10.1177/13524585221114750

Abstract

BACKGROUND: Iron rims (IRs) surrounding white matter lesions (WMLs) are suggested to predict a more severe disease course. Only small longitudinal cohorts of patients with and without iron rim lesions (IRLs) have been reported so far.

OBJECTIVE: To assess whether the presence and number of IRLs in patients with clinically isolated syndrome (CIS) and multiple sclerosis (MS) are associated with long-term disability or progressive disease.

METHODS: Ninety-one CIS/MS patients were recruited between 2008 and 2013 and scanned with 7 T magnetic resonance imaging (MRI). Expanded Disability Status Scale (EDSS) was used to calculate Age-related Multiple Sclerosis Severity Score (ARMSS) at the time of scan and at the latest clinical follow-up after 9 years. WMLs were assessed for the presence of IRL using Susceptibility weighted imaging (SWI)-filtered phase images.

RESULTS: In all, 132 IRLs were detected in 42 patients (46%); 9% of WMLs had IRs; 54% of the cohort had no rims, 30% had 1-3 rims and 16% had ⩾4. Patients with IRL had a higher EDSS and ARMSS. Presence of IRL was also a predictor of long-term disability, especially in patients with ⩾4 IRLs. IRLs have a greater impact on disability compared to the WML number and volume.

CONCLUSION: The presence and number of perilesional IR on MRI hold prognostic value for long-term clinical disability in MS.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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