Clinical Scorecard: Characteristic Phase-Rim Lesions in Multiple Sclerosis Identified by Deep 3D-T1-TFE Hypointense Voxels
At a Glance
Category
Detail
Condition
Multiple sclerosis (MS), a neurodegenerative and inflammatory demyelinating disease
Key Mechanisms
Chronic smoldering inflammation indicated by phase-rim lesions (PRLs) and slowly expanding lesions (SELs), associated with T1 hypointense lesions
Target Population
Patients with relapsing–remitting MS (RRMS) and secondary progressive MS (SPMS)
Care Setting
Neurology and radiology departments with access to advanced MRI imaging
Key Highlights
PRLs and SELs are imaging markers correlated with chronic inflammation and worse prognosis in MS.
PRLs are subtle and require susceptibility-weighted imaging (SWI), often at 3 T or higher MRI field strengths, for detection.
Deep hypointensity on 3D T1 inversion recovery-gradient echo sequences (e.g., 3DT1TFE) corresponds to PRLs and may serve as a surrogate marker.
Guideline-Based Recommendations
Diagnosis
Use advanced MRI protocols including SWI to identify phase-rim lesions in MS patients.
Incorporate 3D T1 inversion recovery-gradient echo sequences (e.g., 3DT1TFE) to detect deeply hypointense lesions associated with PRLs.
Consider both FLAIR and SWI sequences for comprehensive lesion assessment.
Management
Early detection of transformation to progressive MS is critical to optimize treatment strategies.
Utilize disease-modifying therapies effective in relapsing and progressive MS forms to slow disability progression.
Monitoring & Follow-up
Regular MRI follow-up including SWI and 3D T1 sequences to monitor lesion evolution and detect smoldering inflammation.
Quantitative assessment of PRLs and SELs may inform prognosis and therapeutic response.
Risks
Standard MRI protocols without SWI may miss PRLs, delaying recognition of progressive disease.
Misidentification of PRLs due to their subtle imaging characteristics may affect clinical decision-making.
Patient & Prescribing Data
MS patients, including both RRMS and SPMS subtypes
Newly approved treatments can slow disability progression in SPMS, underscoring the importance of early detection of progressive disease markers such as PRLs.
Clinical Best Practices
Incorporate SWI sequences into MRI protocols for MS patients when feasible to improve detection of PRLs.
Use 3D T1 inversion recovery-gradient echo sequences (e.g., 3DT1TFE) for enhanced visualization of hypointense lesions.
Match imaging findings with clinical status to guide timely therapeutic interventions.
Maintain standardized image acquisition and processing protocols to ensure reproducibility and accurate lesion characterization.
by Pablo Naval-Baudin, Albert Pons-Escoda, Àngels Camins, Pablo Arroyo, Mildred Viveros, Josep Castell, Mònica Cos, Antonio Martínez-Yélamos, Sergio Martínez-Yélamos, Carles Majós
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