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Long-term dynamics of multiple sclerosis iron rim lesions

BACKGROUND: Several studies have pointed out that seemingly chronic multiple sclerosis (MS) lesions may also be in inflammatory states. In pathological studies, up to 40% of chronic MS lesions are characterized as "chronic active" or "smoldering" lesions that are characterized by...

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Main Authors: Weber, Claudia Ellen (Author) , Wittayer, Matthias Sebastian (Author) , Kraemer, Matthias (Author) , Dabringhaus, Andreas (Author) , Bail, Kathrin (Author) , Platten, Michael (Author) , Schirmer, Lucas (Author) , Gass, Achim (Author) , Eisele, Philipp (Author)
Format: Article (Journal)
Language:English
Published: 2022
In: Multiple Sclerosis and Related Disorders
Year: 2022, Volume: 57, Pages: 1-10
ISSN:2211-0356
DOI:10.1016/j.msard.2021.103340
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/j.msard.2021.103340
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Author Notes:Claudia E. Weber, Matthias Wittayer, Matthias Kraemer, Andreas Dabringhaus, Kathrin Bail, Michael Platten, Lucas Schirmer, Achim Gass, Philipp Eisele

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245 1 0 |a Long-term dynamics of multiple sclerosis iron rim lesions  |c Claudia E. Weber, Matthias Wittayer, Matthias Kraemer, Andreas Dabringhaus, Kathrin Bail, Michael Platten, Lucas Schirmer, Achim Gass, Philipp Eisele 
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520 |a BACKGROUND: Several studies have pointed out that seemingly chronic multiple sclerosis (MS) lesions may also be in inflammatory states. In pathological studies, up to 40% of chronic MS lesions are characterized as "chronic active" or "smoldering" lesions that are characterized by a rim of iron-laden proinflammatory macrophages/microglial cells at the lesion edge with low-grade continuous myelin breakdown. In vivo, these lesions can be visualized as "iron rim lesions" (IRLs) on susceptibility-weighted imaging (SWI). The aim of this study was to investigate the long-term dynamics of IRLs in vivo for a more detailed evolution of dynamic lesion volume changes occurring over time. - METHODS: We retrospectively identified patients with MS who were followed for at least 36 months (up to 72 months) and underwent at least an annual MRI on the same 3 Tsystem. Using Voxel-Guided Morphometry (VGM) we investigated regional volume changes within lesions and correlated these findings with SWI for the presence of a characteristic hypointense lesion rim. To estimate tissue damage, apparent diffusion coefficient (ADC) values for every lesion at baseline and follow-up MRIs were determined. - RESULTS: Forty-three patients were included in the study. Overall, we identified 302 supratentorial non-confluent MS lesions (52 persistent IRLs, nine transient IRLs, 228 non-IRLs and 13 acute contrast-enhancing lesions). During follow-up, persistent IRLs significantly enlarged, whereas non-IRLs showed a tendency to shrink. At baseline MRI, ADC values were significantly higher in persistent IRLs (1.23 × 10-3 mm/s2) compared to non-IRLs (1.01 × 10-3 mm/s2; p < 0.001), but not compared to transient IRLs (1.06 × 10-3 mm/s2; p = 0.15) and contrast-enhancing lesions (1.15 × 10-3 mm/s2; p = 1.0). During follow-up, ADC values significantly increased more often in persistent IRLs compared to all other lesion types (p < 0.0001). - CONCLUSIONS: Our long-term data demonstrate that persistent IRLs enlarge during disease duration, whereas non-IRLs show a tendency to shrink. Furthermore, IRLs are associated with sustained tissue damage, supporting the notion that IRLs could represent a new imaging biomarker in MS. 
650 4 |a Brain 
650 4 |a Chronic active lesions 
650 4 |a Humans 
650 4 |a Iron 
650 4 |a Iron rim lesions 
650 4 |a Magnetic Resonance Imaging 
650 4 |a MRI 
650 4 |a Multiple sclerosis 
650 4 |a Multiple Sclerosis 
650 4 |a Retrospective Studies 
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