Iron-rim lesions are probably the same than smouldering lesions.
Association of iron rim lesions with brain and cervical cord volume in relapsing multiple sclerosis
https://link.springer.com/article/10.10 ... 21-08233-w
Objectives
In multiple sclerosis (MS), iron rim lesions (IRLs) are indicators of chronic low-grade inflammation and ongoing tissue destruction. The aim of this study was to assess the relationship of IRLs with clinical measures and magnetic resonance imaging (MRI) markers, in particular brain and cervical cord volume.
Methods
Clinical and MRI parameters from 102 relapsing MS patients (no relapses for at least 6 months, no contrast-enhancing lesions) were included; follow-up data obtained after 12 months was available in 49 patients. IRLs were identified on susceptibility-weighted images (SWIs). In addition to standard brain and spinal cord MRI parameters, normalised cross-sectional area (nCSA) of the upper cervical cord was calculated.
Results
Thirty-eight patients had at least one IRL on SWI MRI. At baseline, patients with IRLs had higher EDSS scores, higher lesion loads (brain and spinal cord), and lower cortical grey matter volumes and a lower nCSA. At follow-up, brain atrophy rates were higher in patients with IRLs. IRLs correlated spatially with T1-hypointense lesions.
Conclusions
Relapsing MS patients with IRLs showed more aggressive MRI disease characteristics in both the cross-sectional and longitudinal analyses.
Key Points
• Multiple sclerosis patients with iron rim lesions had higher EDSS scores, higher brain and spinal cord lesion loads, lower cortical grey matter volumes, and a lower normalised cross-sectional area of the upper cervical spinal cord.
• Iron rim lesions are a new lesion descriptor obtained from susceptibility-weighted MRI. Our data suggests that further exploration of this lesion characteristic in regard to a poorer prognosis in multiple sclerosis patients is warranted.
iron-rim lesions importance
Update: Iron-rim lesions and smouldering lesions are the same
Highlights
• We investigated long-term follow-up of multiple sclerosis (MS) iron rim lesions (IRLs)
• During follow-up, persistent IRLs significantly enlarged, whereas non-IRLs showed a tendency to shrink
• During follow-up, apparent diffusion coefficient values significantly increased in persistent IRLs
• IRLs are associated with sustained tissue damage
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.
• We investigated long-term follow-up of multiple sclerosis (MS) iron rim lesions (IRLs)
• During follow-up, persistent IRLs significantly enlarged, whereas non-IRLs showed a tendency to shrink
• During follow-up, apparent diffusion coefficient values significantly increased in persistent IRLs
• IRLs are associated with sustained tissue damage
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.
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