Thomas Berger: Paramagnetic Rim Lesions and Chronic Inflammation in Multiple Sclerosis

In this short video interview, Thomas Berger explains how insights from neuropathology and advanced MRI have improved our understanding of the long-term evolution of MS lesions. He describes paramagnetic rim lesions as markers of chronic, slowly expanding inflammation driven by microglia and iron accumulation, rather than inactive or “burned-out” scars.

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What do paramagnetic rim lesions reveal about chronic inflammation and disease progression in multiple sclerosis?

In the interview, Thomas Berger focuses on what paramagnetic rim lesions represent biologically and clinically. He outlines how these lesions reflect a persistent, altered inflammatory activity at the lesion edge, shaped by microglial responses and iron handling, and why this matters for understanding disease progression and therapeutic strategy in multiple sclerosis.

Key points discussed include:

• MS lesions evolve over time, with inflammatory activity changing both qualitatively and quantitatively
• Paramagnetic rim lesions reflect ongoing, slowly expanding inflammation rather than inactive “burned-out” scars
• The central role of microglia and iron accumulation in chronic lesion activity
• How advanced MRI techniques allow visualization of these persistent inflammatory processes
• The dynamic nature of chronic lesions over years
• What current evidence suggests about their relationship with disability progression
• Why therapeutic implications remain under investigation
• The importance of interpreting MRI findings within a long-term perspective of MS as a continuous inflammatory–neurodegenerative disease

Could you explain how do PRLs differ from other chronic active lesions, and what do they tell us about ongoing inflammation?

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Key messages from Thomas Berger

Paramagnetic rim lesions offer important insight into the chronic inflammatory dimension of multiple sclerosis, but their interpretation requires caution and a long-term perspective. In this interview, Thomas Berger underscores that MS lesions are dynamic structures, evolving over years from acute inflammatory activity to more slowly expanding, microglia-driven processes that bridge inflammation and neurodegeneration.

Rather than representing inactive scars, paramagnetic rim lesions signal a persistent and altered inflammatory state. Although advanced MRI techniques now allow their visualization and emerging data suggest associations with progression, their precise clinical implications are still evolving.

Ultimately, the discussion reinforces a biologically grounded and measured approach: while novel imaging markers deepen our understanding of disease mechanisms, early and effective anti-inflammatory treatment remains the most reliable strategy to limit long-term damage in a disease that unfolds continuously over time.

Curious to learn more about the expert behind this interview?

Visit Thomas Berger’s full biography for more insights into his expertise.

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