Hidden Pitfall in Multiple Sclerosis Imaging: How Standard Susceptibility-Weighted Imaging (SWI) May Miss Paramagnetic Rim Lesions

Yuki Sonoda; Akifumi Hagiwara; Yuji Tomizawa; Yasunobu Hoshino; Junko Kikuta; Hideo Kawasaki; Moto Nakaya; Satoru Kamio; Ryutaro Yano; Hiroshi Kusahara; Taku Hatano; Koji Kamagata; Shigeki Aoki

doi:10.2463/mrms.bc.2025-0073

Yuki Sonoda, Akifumi Hagiwara , Yuji Tomizawa, Yasunobu Hoshino, Junko Kikuta, Hideo Kawasaki, Moto Nakaya, Satoru Kamio, Ryutaro Yano, Hiroshi Kusahara, Taku Hatano, Koji Kamagata, Shigeki Aoki

Author information

Yuki Sonoda
Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Akifumi Hagiwara Corresponding author
Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Yuji Tomizawa
Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
Yasunobu Hoshino
Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
Junko Kikuta
Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
Hideo Kawasaki
Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
Moto Nakaya
Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Satoru Kamio
Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Ryutaro Yano
Canon Medical Systems Corporation, Kawasaki, Kanagawa, Japan
Hiroshi Kusahara
Canon Medical Systems Corporation, Kawasaki, Kanagawa, Japan
Taku Hatano
Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
Koji Kamagata
Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
Shigeki Aoki
Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

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

JOURNAL OPEN ACCESS Advance online publication

Article ID: bc.2025-0073

DOI https://doi.org/10.2463/mrms.bc.2025-0073

Details

Abstract

This case report shows that paramagnetic rim lesions (PRLs), markers of chronic active lesions in multiple sclerosis, vary in visibility depending on scan-parameters of susceptibility-weighted imaging (SWI). Routine SWI for microbleed detection with low flip angle (FA) failed to depict PRLs, while longer TE and higher FA improved visibility. Phase images consistently visualized PRLs. These findings underscore the need to optimize TE and FA, as suboptimal SWI settings may hinder PRL detection.

Corresponding author

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