Evidence map›Paper›PMID 40893055›Full record

Observational studyNeurology2025

Frequency and Diagnostic Implications of Paramagnetic Rim Lesions in People Presenting for Diagnosis to a Multiple Sclerosis Clinic.

Brian Renner, Elizabeth Daphne Verter, Martina Absinta, Lynn Daboul, Praneeta Raza, Melissa Lynne Martin, Quy Cao, Carly M O'Donnell, Paulo R Rodrigues, Marc Ramos and 22 more

Abstract readObservational StudyMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Neurology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

32 authors.

Brian RennerDepartment of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA.ORCID 0000-0003-3729-5255
Elizabeth Daphne VerterDepartment of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA.ORCID 0009-0000-3323-9200
Martina AbsintaDepartment of Biomedical Sciences, Humanitas University, Milan, Italy.ORCID 0000-0003-0276-383X
Lynn DaboulTranslational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD.
Praneeta RazaOutcomes Research Consortium, Houston, TX.
Melissa Lynne MartinPerelman School of Medicine, University of Pennsylvania, Philadelphia.ORCID 0000-0001-8631-5596
Quy CaoPerelman School of Medicine, University of Pennsylvania, Philadelphia.
Carly M O'DonnellPerelman School of Medicine, University of Pennsylvania, Philadelphia.
Paulo R RodriguesQMENTA Inc., Boston, MA.ORCID 0000-0002-2102-1746
Marc RamosQMENTA Inc., Boston, MA.
Vesna PrchkovskaQMENTA Inc., Boston, MA.
John DerbyshireFunctional MRI Facility, National Institute of Mental Health, Bethesda, MD.
Christina J AzevedoDepartment of Neurology, University of Southern California, Los Angeles.
Amit Bar-OrDepartment of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia.ORCID 0000-0001-7179-0335
Eduardo CaverzasiDepartment of Brain and Behavioral Sciences, University of Pavia, Italy.ORCID 0000-0002-0350-0460
Peter A CalabresiDepartment of Neurology, Johns Hopkins University, Baltimore, MD.ORCID 0000-0002-7776-6472
Bruce Anthony Campbell CreeDepartment of Neurology, Weill Institute for Neurosciences, San Francisco, CA.ORCID 0000-0001-7689-2533
Leorah FreemanDepartment of Neurology, Dell Medical School, The University of Texas at Austin.
Roland G HenryDepartment of Neurology, Weill Institute for Neurosciences, San Francisco, CA.ORCID 0000-0002-8232-7562
Erin E LongbrakeDepartment of Neurology, Yale University, New Haven, CT.ORCID 0000-0002-1179-3937
Jiwon OhDivision of Neurology, St. Michael's Hospital University of Toronto, Canada.ORCID 0000-0001-5519-6088
Nico PapinuttoDepartment of Neurology, Weill Institute for Neurosciences, San Francisco, CA.ORCID 0000-0003-2184-4782
Daniel PelletierDepartment of Neurology, University of Southern California, Los Angeles.
Rohini D SamudralwarDepartment of Neurology, University of Texas Health Science Center, Houston.ORCID 0000-0003-1224-4996
Matthew K SchindlerDepartment of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia.ORCID 0000-0003-0157-5669
Elias S SotirchosDepartment of Neurology, Johns Hopkins University, Baltimore, MD.ORCID 0000-0002-8812-1637
Nancy L SicotteDepartment of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA.ORCID 0000-0002-5131-3352
Andrew J SolomonDepartment of Neurological Sciences, Larner College of Medicine of The University of Vermont, Burlington.ORCID 0000-0003-1602-1554
Russell T ShinoharaPerelman School of Medicine, University of Pennsylvania, Philadelphia.ORCID 0000-0001-8627-8203
Daniel S ReichTranslational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD.ORCID 0000-0002-2628-4334
Daniel OntanedaMellen Center for Multiple Sclerosis, Cleveland Clinic, OH.ORCID 0000-0002-2838-9148
Pascal SatiDepartment of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA.ORCID 0000-0002-6763-0125

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

objectivesParamagnetic rim lesions (PRLs) are a well-established imaging biomarker of chronic active multiple sclerosis (MS) lesions. PRLs have been shown to be highly specific for MS (∼90% specificity), and their prevalence has been estimated to be approximately 50% in patients with clinically established diagnoses of MS. In this study, we evaluated the frequency and diagnostic value of PRLs in patients at first clinical presentation.

methodsAdults age 18-64 years presenting with clinical symptoms or radiologic suspicion of demyelinating disease referred to academic specialty MS centers without a definitive diagnosis were prospectively enrolled in a multicenter, cross-sectional, observational study. Phase images from high-resolution 3D echo-planar imaging were acquired on 3-tesla brain MRI and evaluated for PRLs by 3 independent raters, blinded to diagnosis, with adjudication from a fourth expert rater. Diagnostic performance of PRLs for a diagnosis of MS using the 2017 McDonald criteria as gold standard was evaluated using diagnostic thresholds based on the presence of at least 1 PRL (≥1 PRL) or at least 2 PRLs (≥2 PRLs).

resultsSeventy-eight participants were analyzed (mean age, years [range]: 45.0 [18-64] female sex n = 55 [71%]); a total of 124 PRLs were counted in 36 (46%) of the 78 participants (median: 3 PRLs; range: 1-9 PRLs). Thirty-two (89%) of the 36 PRL-positive participants fulfilled 2017 McDonald criteria, and the remaining 4 (11%) had an alternate diagnosis. The presence of ≥1 PRL had a sensitivity of 0.86 (95% CI 0.71-0.95) and a specificity of 0.90 (95% CI 0.77-0.97). For ≥2 PRLs, specificity increased to 0.95 (95% CI 0.83-0.99), whereas sensitivity decreased to 0.59 (95% CI 0.42-0.75). For participants with MS, shorter duration from initial symptom onset was associated with higher probability of having PRLs, with the odds of being PRL positive (≥1 PRL) increasing by 28% for every 1 year decrease from symptom onset (odds ratio 1.28 per year, 95% CI 1.03-1.59, DISCUSSION: PRLs are highly prevalent early in patients with MS at the time of first clinical presentation and can differentiate MS from mimics with high accuracy.

Indexed as

BrainMultiple SclerosisAdolescentAdultCross-Sectional StudiesEcho-Planar ImagingFemaleHumansMagnetic Resonance ImagingMaleMiddle AgedProspective StudiesSensitivity and SpecificityYoung Adult

Identifiers

PMID40893055
PMCPMC12596004

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.