BACKGROUND AND PURPOSE: Previous studies have suggested that the central vein sign and iron rims are specific features of MS lesions. Using 3T SWI, we aimed to compare the frequency of lesions with central veins and iron rims in patients with clinically isolated syndrome and MS-mimicking disorders and test their diagnostic value in predicting conversion from clinically isolated syndrome to MS.
MATERIALS AND METHODS:For each patient, we calculated the number of brain lesions with central veins and iron rims. We then identified a simple rule involving an absolute number of lesions with central veins and iron rims to predict conversion from clinically isolated syndrome to MS. Additionally, we tested the diagnostic performance of central veins and iron rims when combined with evidence of dissemination in space.
RESULTS:We included 112 patients with clinically isolated syndrome and 35 patients with MS-mimicking conditions. At follow-up, 94 patients with clinically isolated syndrome developed MS according to the 2017 McDonald criteria. Patients with clinically isolated syndrome had a median of 2 central veins (range, 0-19), while the non-MS group had a median of 1 central vein (range, 0-6). Fiftysix percent of patients who developed MS had $1 iron rim, and none of the patients without MS had iron rims. The sensitivity and specificity of finding $3 central veins and/or $1 iron rim were 70% and 86%, respectively. In combination with evidence of dissemination in space, the 2 imaging markers had higher specificity than dissemination in space and positive findings of oligoclonal bands currently used to support the diagnosis of MS.CONCLUSIONS: A single 3T SWI scan offers valuable diagnostic information, which has the potential to prevent MS misdiagnosis. ABBREVIATIONS: CDMS ¼ clinically definite MS; CIS ¼ clinically isolated syndrome; CV ¼ central vein; DIS ¼ dissemination in space; DIT ¼ dissemination in time; IR ¼ iron rim; NPV ¼ negative predictive value; OCB ¼ oligoclonal band; PPV ¼ positive predictive value M S diagnosis is based on typical clinical symptoms and radiologic findings, and it incorporates the principles of demonstration of demyelinating lesions disseminated in space (DIS) and time (DIT). Radiologically, DIS is demonstrated by the presence of $1 T2-hyperintense lesion characteristic of MS in $2 of the following CNS topographies: periventricular, cortical, or juxtacortical; infratentorial; and spinal cord; and DIT is demonstrated by the simultaneous presence of gadolinium-enhancing and nonenhancing lesions on a single scan or by a new T2 lesion compared with a previous MR imaging scan. Following the 2017 revisions to the McDonald criteria, a positive finding on lumbar
Cervical spondylotic myelopathy (CSM) is a clinical syndrome secondary to a spinal cord compression due to cervical spondylosis. In some cases, conventional MRI typically shows an intramedullary hyperintense signal on T2W imaging and contrast enhancement on post-gadolinium T1W imaging. We report a series of seven patients with CSM who had typical clinical presentation and imaging findings on T2W and contrast-enhanced T1W sequences. The imaging findings included degenerative changes of the cervical spine, intramedullary T2-signal hyperintensity, and an intramedullary enhancement on post-gadolinium T1W images. Our results support the statement that the presence of an intramedullary gadolinium-enhancement with a flat transverse pancake-like pattern (on sagittal images) and a circumferential pattern (on axial images), located within a T2-signal abnormality, in patients with cervical spondylosis and clinical myelopathy is indicative of spondylosis as the cause of the myelopathy.
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