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. 2021 Aug 10;97(6):e543–e553. doi: 10.1212/WNL.0000000000012326

Figure 4. MRI Pathology of Paramagnetic Rim Lesions (PRLs).

Figure 4

Matched MRI–histopathologic assessment of 1 representative chronic active lesion in the cerebral white matter of a 59-year-old patient with PMS (disease duration 24 years, Expanded Disability Status Scale = 8). The paramagnetic rim visible on the postmortem 3D-echoplanar imaging (EPI) phase (red arrows) corresponds on histopathology to an actively inflammatory demyelinating edge of major histocompatibility complex class II clone CR3/43 (MHC II)+ macrophages/microglia containing myelin basic protein (MBP)+ myelin degradation products (MBP-MHC II) and iron (Turnbull-iron [3,3′ diaminobenzidine-tetrahydrochloride–enhanced Turnbull staining]). Amyloid precursor protein (APP)+ acutely injured axons are found at the demyelinated lesion edge (MBP-APP).