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.

Reference

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