Phase Image Display Settings for Paramagnetic Rim Lesion Detection in Multiple Sclerosis: A Practical Guide

Akifumi Hagiwara; Yuki Sonoda; Yuji Tomizawa; Koji Shinoda; Isamu Takai; Yasunobu Hoshino; Junko Kikuta; Taku Hatano; Koji Kamagata

doi:10.2463/mrms.e.2026-2000

EDITORIAL

Phase Image Display Settings for Paramagnetic Rim Lesion Detection in Multiple Sclerosis: A Practical Guide

Akifumi Hagiwara , Yuki Sonoda, Yuji Tomizawa, Koji Shinoda, Isamu Takai, Yasunobu Hoshino, Junko Kikuta, Taku Hatano, Koji Kamagata

Author information

Akifumi Hagiwara Corresponding author
https://orcid.org/0000-0001-5277-3249
Department of Radiology, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
Yuki Sonoda
https://orcid.org/0009-0005-8622-2433
Department of Radiology, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
Yuji Tomizawa
https://orcid.org/0000-0002-5462-6725
Department of Neurology, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
Koji Shinoda
https://orcid.org/0000-0003-3818-9008
Department of Neurology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, Fukuoka 812-8582, Japan
Isamu Takai
Department of Neurology, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
Yasunobu Hoshino
Department of Neurology, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
Junko Kikuta
https://orcid.org/0000-0003-1324-8614
Department of Radiology, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
Taku Hatano
https://orcid.org/0000-0002-6808-0444
Department of Neurology, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
Koji Kamagata
https://orcid.org/0000-0001-5028-218X
Department of Radiology, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan

Keywords: multiple sclerosis, paramagnetic rim lesion, phase image, susceptibility-weighted imaging

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Supplementary material

2026 Volume 25 Issue 4 Article ID: e.2026-2000

DOI https://doi.org/10.2463/mrms.e.2026-2000

Details

Abstract

The 2024 revisions of the McDonald criteria incorporate the paramagnetic rim lesion (PRL) into the diagnostic framework of multiple sclerosis, and PRL evolution is increasingly recognized as a marker of disease progression. PRLs are detected on phase images of susceptibility-sensitive sequences, but their visibility depends critically on display settings. Current consensus recommendations provide detailed guidance on acquisition parameters yet do not address the phase-image window/level applied at the reading workstation; an inappropriate phase window can render rims invisible. We discuss practical tips for reliable PRL detection, including awareness of vendor-specific phase conventions, windowing to optimize conspicuity, and hands-on training, to support accurate and reproducible PRL assessment in routine clinical practice.

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