Central Vein Sign at 3T MRI Specific in Differentiating MS From Other Diseases

doctors looking at MRI of brain
doctors looking at MRI of brain
Central vein sign at 3T ultrahigh-field magnetic resonance imaging is highly specific and moderately sensitive in the differentiation of multiple sclerosis from other diseases.

Central vein sign at 3 tesla (T) ultrahigh-field magnetic resonance imaging (MRI) is highly specific and moderately sensitive in the differentiation of multiple sclerosis (MS) from other diseases, a study in JAMA Neurology suggests.

The study enrolled a total of 606 patients from ongoing observational studies as well as neuroimaging research databases of neuroimaging centers across Europe. Researchers included only patients who underwent a 3T MRI scan and who had the following diagnoses: clinically isolated syndrome, relapsing-remitting MS, neuromyelitis optica spectrum disorder, systemic lupus erythematosus, cerebral vasculitis, episodic migraine, cluster headache, or small vessel disease.

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Among the 353 patients with clinically isolated syndrome and relapsing-remitting MS, 235 (66.6%) were women (median age 37 [14.7-61.4]). In 487 patients, 4447 lesions were analyzed. Researchers blinded to participants’ diagnoses analyzed the occurrence of central vein sign as detected by 3T T2*-weighted or susceptibility-weighted imaging. The MRI sequences were assessed for sensitivity and specificity in distinguishing patients with MS vs patients with other diagnoses.

Using a 35% central vein sign proportion threshold, the researchers found a sensitivity of 68.1% and a specificity of 82.9% for distinguishing MS from non-MS conditions. Comparatively, the presence of 3 central vein sign lesions had a sensitivity and specificity of 61.9% and specificity of 89.0%, respectively. The use of an optimized T2*-weighted sequence was associated with an even higher sensitivity. It was most helpful for differentiating MS and clinically isolated syndrome from not MS and featured a sensitivity of 100% and specificity of 86.7% using the 35% central vein sign proportion threshold.

Limitations of the study were the exclusion of lesions <3 mm in size as well as the unequal distribution of patients across the different imaging protocols.

The researchers concluded that the 3 central vein sign lesion criteria in conjunction with the 35% central vein sign proportion threshold is highly sensitive in differentiating MS from non-MS conditions and that the application of T2*-weighted imaging may further increase this sensitivity. They believe additional larger prospective studies are needed “to confirm this study’s cross-sectional findings and to identify whether central vein sign–based criteria can be used in clinical practice to support the diagnosis of MS.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Sinnecker T, Clarke MA, Meier D, et al; for the MAGNIMS Study Group. Evaluation of the central vein sign as a diagnostic imaging biomarker in multiple sclerosis [published online August 19, 2019]. JAMA Neurol. doi:10.1001/jamaneurol.2019.2478