Absinta M, Sati P, Masuzzo F, et al. - In this in vivo cohort study, researchers ascertained if rim lesions were correlated with a patient disability and long-term lesion outcomes. Of 209 candidates, 104 were women and 32 were African American. The association has been shown to have chronic active/slowly expanding/smoldering multiple sclerosis (MS) lesions with aggressive disease course and poor clinical results despite authorized disease-modifying treatment, which are detectable on high-field susceptibility-based MRI due to their distinctive paramagnetic rims. Over time, rim lesions do not shrink slowly as other lesions do, but as a result of ongoing demyelination typically remain stable or even enlarge. These data provide in vivo proof that inflammation in chronic active plaques is a prominent characteristic of MS associated with accumulation of disability, indicating a path for new clinical trials of MRI based on susceptibility to test new kinds of therapy to improve this process.