Central vein sign for multiple sclerosis: A systematic review and meta-analysis

Bhandari, Abhishta; Xiang, Hua; Lechner‐Scott, Jeannette; Agzarian, Marc

doi:10.1016/j.crad.2020.01.011

Cited by 15 publications

(11 citation statements)

References 28 publications

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“…23,24 Of the new lesions that were eligible for CVS analysis, 68% were CVS+, which is in line with the overall rates of cross-sectional baseline CVS+ percentage previously described in MS, illustrating how these percentages evolve from the accumulation of new, primarily CVS+, lesions over time. 10,12 In contrast, neurologically normal HC with nonspecific T2/FLAIR hyperintensities on baseline MRI were less likely to form new lesions over time compared to MS cases; in the 2 HC who formed new lesions, both lesions were CVS−, consistent with their lower baseline CVS+ percentage.…”

Section: Discussionmentioning

confidence: 89%

“…The central vein sign (CVS) is a central linear hypointensity within lesions, visualized on susceptibility-sensitive MRI sequences (such as T2*-weighted scans) and corresponding to the small vein or venule around which the lesion formed. 9 , 10 The CVS has been proposed as a radiologic biomarker and is seen with high frequency in MS lesions, 11 , 12 such that it can effectively differentiate MS from other etiologies associated with nonspecific white matter lesions. 13 , 14 However, whereas the CVS has shown promise in aiding the initial diagnosis of MS based on the evaluation of established lesions, the CVS characteristics of newly appearing T2/FLAIR or Gd+ lesions in MS have not been comprehensively described.…”

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confidence: 99%

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Central Vein Sign Profile of Newly Developing Lesions in Multiple Sclerosis

Al‐Louzi

Letchuman

Manukyan

et al. 2022

Neurol Neuroimmunol Neuroinflamm

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Background and ObjectivesThe central vein sign (CVS), a central linear hypointensity within lesions on T2*-weighted imaging, has been established as a sensitive and specific biomarker for the diagnosis of multiple sclerosis (MS). However, the CVS has not yet been comprehensively studied in newly developing MS lesions. We aimed to identify the CVS profiles of new white matter lesions in patients with MS followed over time and investigate demographic and clinical risk factors associated with new CVS+ or CVS− lesion development.MethodsIn this retrospective longitudinal cohort study, adults from the NIH MS Natural History Study were considered for inclusion. Participants with new T2 or enhancing lesions were identified through review of the radiology report and/or longitudinal subtraction imaging. Each new lesion was evaluated for the CVS. Clinical characteristics were identified through chart review.ResultsA total of 153 adults (95 relapsing-remitting MS, 27 secondary progressive MS, 16 primary progressive MS, 5 clinically isolated syndrome, and 10 healthy; 67% female) were included. Of this cohort, 96 had at least 1 new T2 or contrast-enhancing lesion during median 3.1 years (Q1–Q3: 0.7–6.3) of follow-up; lesions eligible for CVS evaluation were found in 62 (65%). Of 233 new CVS-eligible lesions, 159 (68%) were CVS+, with 30 (48%) individuals having only CVS+, 12 (19%) only CVS−, and 20 (32%) both CVS+ and CVS− lesions. In gadolinium-enhancing (Gd+) lesions, the CVS+ percentage increased from 102/152 (67%) at the first time point where the lesion was observed, to 92/114 (82%) after a median follow-up of 2.8 years. Younger age (OR = 0.5 per 10-year increase, 95% CI = 0.3–0.8) and higher CVS+ percentage at baseline (OR = 1.4 per 10% increase, 95% CI = 1.1–1.9) were associated with increased likelihood of new CVS+ lesion development.DiscussionIn a cohort of adults with MS followed over a median duration of 3 years, most newly developing T2 or enhancing lesions were CVS+ (68%), and nearly half (48%) developed new CVS+ lesions only. Importantly, the effects of edema and T2 signal changes can obscure small veins in Gd+ lesions; therefore, caution and follow-up is necessary when determining their CVS status.Trial Registration InformationClinical trial registration number NCT00001248.Classification of EvidenceThis study provides Class III evidence that younger age and higher CVS+ percentage at baseline are associated with new CVS+ lesion development.

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Section: Discussionmentioning

confidence: 89%

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confidence: 99%

Central Vein Sign Profile of Newly Developing Lesions in Multiple Sclerosis

Al‐Louzi

Letchuman

Manukyan

et al. 2022

Neurol Neuroimmunol Neuroinflamm

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“…Certainly, there is some relationship of demyelination with veins, at least a relationship of vicinity as pathogenetic relationship is not very clear [11] . Demyelinating disorders specifically Multiple Sclerosis is generally considered a “peri-venous disease” [ 12 , 13 ] and lately, supported by manifestation of “Central Vein Sign” on high field MRI. More interesting would be the potential role of hypoxemic injury causing demyelinating COVID-19 related leukoencephalopathy in the setting of sustained respiratory dysfunction.…”

Section: Discussionmentioning

confidence: 99%

COVID-Related Leukoencephalopathy: Unusual MRI Features and Comparability to Delayed Post Hypoxic Ischemic Encephalopathy

Ahmed

Gaba

Khan

et al. 2022

Radiology Case Reports

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COVID-19 related leukoencephalopathy can be multifactorial given the systemic effects of the viral disease. We present couple of cases with typical clinico-imaging stigmata of COVID-19 resulting in severe respiratory insufficiency. MR brain imaging revealed confluent diffuse supratentorial white matter T2 hyperintensity with restricted diffusion during the sub-acute course of the disease. The MR imaging pattern of leukoencephalopathy was non-specific but more comparable to delayed post-hypoxic leukoencephalopathy (DPHL) as also previously reported in COVID-19. Interestingly, T2 imaging showed unusual but peculiar finding of “accentuated medullary veins” in the superficial zones. No dural venous sinus thrombosis or micro-hemorrhages were present to explain “dots and stripes” due to dilated medullary veins. The patho-mechanism of this findings is not clear but may possibly be related to demyelination as DPHL has shown to be a demyelinating process. We present a review of COVID-related leukoencephalopathy with discussion on hypoxia-induced demyelinating process with accentuated medullary veins as possible associated marker.

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“…Можно выделить два основных направления исследований в данной области: 1) выявление симптома центральной вены при РС и сравнение полученных данных с таковыми при РС-подобных заболеваниях (прочих демиелинизирующих, сосудистых, аутоиммунных), которые имеют схожую МРТ-картину при рутинном обследовании; 2) определение доли очагов с симптомом центральной вены (в разных исследованиях порог колеблется от 40 до 50%) или минимального количества таких очагов для повышения чувствительности и специфичности метода [11]. О б з о р и с с л е д о в а н и й , п о с в я щ е н н ы х д а н н о й т е м е E.C.…”

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“…[20] получены следующие данные: порог перивенулярных очагов 45% имеет 97% чувствительность и 99% специфичность, причем в обзор были включены исследования, проводившиеся на то-мографах1,5; 3 и 7 Т. В другом обзоре с метаанализом A. Bhandari и соавт. [11] выявлен практически аналогичный порог перивенулярных очагов -46,4%, но выбрано удобное значение в 45%. Также отмечено, что данный симптом может быть обнаружен на томографах как 3, так и 1,5 Т и что подсчет очагов исследователем более точен, чем компьютерный анализ.…”

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The central vein sign in the differential diagnosis of multiple sclerosis

Belov

Boyko

2020

RJTAO

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The current diagnosis of multiple sclerosis (MS) is based on confirmation of the disseminated pathological process in space and time in accordance with the McDonald criteria. Despite this, the search continues for specific markers of the disease, including those detected using neuroimaging techniques that have high sensitivity and specificity in the diagnosis of MS.The paper considers the central vein sign, a new promising diagnostic one of MS. This sign refers to a parenchymal vein visualized in the focus of demyelination, by using special magnetic resonance imaging (MRI) modes. Studies show that the central vein sign has high sensitivity and specificity in the diagnosis of MS, allowing it to be differentiated from other demyelinating, vascular, and systemic diseases that have an MRI pattern similar to that of MS. According to various authors, a threshold of 40–50% perivenular lesions allows MS and MS-like diseases to be differentiated with high accuracy.

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Central vein sign for multiple sclerosis: A systematic review and meta-analysis

Cited by 15 publications

References 28 publications

Central Vein Sign Profile of Newly Developing Lesions in Multiple Sclerosis

Central Vein Sign Profile of Newly Developing Lesions in Multiple Sclerosis

COVID-Related Leukoencephalopathy: Unusual MRI Features and Comparability to Delayed Post Hypoxic Ischemic Encephalopathy

The central vein sign in the differential diagnosis of multiple sclerosis

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