Imaging central veins in brain lesions with 3-T T2*-weighted magnetic resonance imaging differentiates multiple sclerosis from microangiopathic brain lesions

Abstract

3-T T2*-weighted brain MRI distinguishes perivenous MS lesions from microangiopathic lesions. Clinical application of this technique could supplement existing diagnostic algorithms.

Central vein sign differentiates Multiple Sclerosis from central nervous system inflammatory vasculopathies

“…The 50% rule and the 40% rule showed higher diagnostic accuracy in comparison to the 6‐lesion rule20 and the 3‐lesion rule 29. Diagnostic specificity, sensitivity, and accuracy are shown in Table 3.…”

“…Similarly, we also dichotomized patients based on 3 previously published suggested criteria: (1) the “40% rule,” whereby a threshold of 40% perivenular lesions distinguishes MS from non‐MS17; (2) the “6‐lesion rule,” whereby 10 lesions are randomly assessed and MS is diagnosed if at least 6 lesions are perivenular20; and (3) the “3‐lesion rule,” whereby 3 lesions are randomly assessed and MS is diagnosed if these 3 lesions are perivenular 29…”

The central vein sign and its clinical evaluation for the diagnosis of multiple sclerosis: a consensus statement from the North American Imaging in Multiple Sclerosis Cooperative

“…More recently, an even simpler set of diagnostic rules for CVS was introduced, consisting of the following three criteria 18 : if there are six or more morphologically characteristic lesions, the diagnosis is inflammatory demyelination; if there are fewer than six morphologically characteristic lesions, but morphologically characteristic lesions outnumber non-perivenous lesions, the diagnosis is inflammatory demyelination; if neither of these conditions are met, inflammatory demyelination should not be diagnosed. The morphologically characteristic lesions considered here had a 'coffee bean' or 'Dawson's finger' appearance when the MRI slice was along the vein's axis, and a 'ring' or 'doughnut' appearance when the MRI slice was approximately perpendicular to the vein.…”

“…The 'central vein sign' (CVS) has been investigated in various neurological conditions by several groups, and evidence has accumulated that the CVS may have the ability to accurately differentiate MS from its mimics [15][16][17][18][19][20][21] . As a consequence, recent guidelines from the Magnetic Resonance Imaging in MS (MAGNIMS) group 1,4 and the Consortium of MS Centers (CMSC) task force 22 have acknowledged the potential of the CVS and its dedicated MRI acquisitions for the differential diagnosis of MS, while calling for further research before considering a possible modification of the diagnostic criteria.…”

Reducing costs while enhancing quality of care in MS

“…The existing criteria for MS (Barkhof, Swanton) are designed not for diagnosing MS, but for identifying patients with clinically isolated syndrome-first MS-like neurologic event-who are at high risk of developing MS. 5,e3 We urgently need practical radiographic criteria or other biomarkers for ruling out MS in a patient with low pretest probability of this disease and MS-atypical lesions, and ruling in patients with clinically or radiologically isolated syndromes that often precede clinical MS. One promising strategy is to optimize MRI sequences for detection of features suggestive of demyelination, such as central veins within lesions. Central veins are found in more than 40% of demyelinating lesions, but rarely in microvascular disease 12 or migraine, e4 and are thus particularly useful in distinguishing between MS and the nonspecific subcortical lesions seen in the other …”