Early Magnetic Resonance Imaging Features of New Paramagnetic Rim Lesions in Multiple Sclerosis

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Objective To determine early magnetic resonance imaging (MRI) features of new multiple sclerosis (MS) lesions that will develop into paramagnetic rim lesions (PRLs), which have been associated with progressive tissue injury in MS. Methods New contrast‐enhancing lesions observed on routine clinical MRI were imaged at 7 T within 4 weeks of observation, and 3 and 6 months later. The 6‐month MRI was used to classify PRL status (PRL or non‐PRL). The relationship between early lesion characteristics and subsequent PRL status was assessed using generalized linear mixed effects models. Random forest classification was performed to classify early predictors of subsequent PRL status. Results From 93 contrast‐enhancing lesions in 23 MS patients, 37 lesions developed into a PRL. In lesions that developed into PRLs compared with those that did not, the average lesion T 1 on the initial 7 T MRI was 1994 ms compared with 1,670 ms ( p ‐value <0.001), and the average volume was 168.7 mL compared with 44 mL ( p ‐value <0.001) in lesions that did not. These volume differences were also found on 3 T scans ( p ‐value <0.001), and for intensity‐normalized T 1 ‐w ( p ‐value = 0.011) and fluid‐attenuated inversion recovery ( p ‐value = 0.005). The area under the receiver operating characteristic curve for the random forest classification with leave‐one‐out cross‐validation was found to be 0.86 using initial 7 T features. Interpretation New MS lesions that evolve into PRLs can be identified early in lesion evolution. These findings suggest that biological mechanisms underlying PRL development begin early, which has important implications for clinical trials targeting PRLs development and subsequent therapeutics. ANN NEUROL 2023;94:736–744

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