Lack of evolution of paramagnetic rim lesions after anti-CD20 treatment. Representative 3D T2∗-weighted magnitude and unwrapped phase MRI images showing paramagnetic rim lesions (PRL) with persistent paramagnetic rims in (a) a 31-year-old with PPMS followed for 39 months, and (b) a 32-year-old with PPMS followed for 40 months, after treatment initiation. In (b), red and yellow arrows delineate two distinct PRL. Abbreviations: MRI, Magnetic resonance imaging; PPMS, Primary progressive MS; PRL, Paramagnetic rim lesions; QSM, Quantitative susceptibility mapping; anti-CD20, anti-CD20 treatment.