Presence of a central vein within white matter lesions on susceptibility weighted imaging: a specific finding for multiple sclerosis?

Lummel, Nina; Boeckh‐Behrens, Tobias; Schoepf, Veronika; Burke, Michael P.; Brückmann, H.; Linn, Jennifer

doi:10.1007/s00234-010-0736-z

Cited by 51 publications

(52 citation statements)

References 22 publications

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“…Our study is one of only several that have demonstrated the feasibility of detection of CVS on 3T MRI in MS,19, 20, 30, 31 and only a few studies have investigated whether the CVS distinguishes MS from other populations at 3T 16, 18. Lummel et al 16.…”

Section: Discussionmentioning

confidence: 90%

“…One such method may be detection of the “central vessel sign” (CVS) 10. It has been known from histopathological studies at autopsy that most MS lesions are centered around veins,11 and only recently have a variety of imaging techniques using susceptibility‐weighted imaging on ultrahigh‐field 7‐tesla (T) research magnets demonstrated this relationship in vivo 12, 13, 14, 15, 16, 17. A small number of studies have also evaluated the ability of 3T scanners, which are used routinely in clinical practice, to detect a “central vessel” (CV) in MS lesions 18, 19, 20, 21.…”

Section: Introductionmentioning

confidence: 99%

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“Central vessel sign” on 3T FLAIR* MRI for the differentiation of multiple sclerosis from migraine

Solomon

Schindler

Howard³

et al. 2015

Ann Clin Transl Neurol

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ObjectiveThe diagnosis of multiple sclerosis (MS) presently relies on radiographic assessments of imperfect specificity. Recent data using T2* methodology for the detection of the “central vessel sign” (CVS) in MS lesions suggests this novel MRI technique may distinguish MS from other disorders. Our aim was to determine if evaluation for CVS on 3T FLAIR* MRI differentiates MS from migraine.MethodsPatients with MS or migraine and a prior brain MRI demonstrating at least two hyperintense lesions ≥3 mm were recruited. Exclusion criteria included any additional comorbidity known to cause brain MRI abnormalities. 3T MRI was performed in each participant with administration of gadopentetate dimeglumine, and FLAIR* images were generated in postprocessing. The total number of discrete ovoid lesions ≥3 mm were counted on FLAIR, per participant, and subsequently evaluated for presence of CVS on FLAIR*. An exploratory method evaluating for CVS in a maximum of 12 lesions per subject was also completed.ResultsTen participants with MS and 10 with migraine completed the study. The median percentage (quartiles) of lesions in MS participants with CVS was 84 (79, 94) compared to 22 (15, 54) in migraine (P = 0.008). In a subanalysis by brain region, in the subcortical and deep white matter, the median percentage (quartiles) of lesions in MS participants with CVS was 88 (81, 100) compared to 19 (11, 54) in migraine (P = 0.004). This difference was not identified in juxtacortical, periventricular, or infratentorial regions.InterpretationIdentification of CVS using FLAIR* on 3T MRI helps differentiate MS from migraine, particularly in the subcortical and deep white matter.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

“Central vessel sign” on 3T FLAIR* MRI for the differentiation of multiple sclerosis from migraine

Solomon

Schindler

Howard³

et al. 2015

Ann Clin Transl Neurol

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“…Some studies have utilized a 3D T2*-weighted GRE sequence to overcome the slice gap issue, and have applied parallel imaging to shorten scan time while maintaining high image resolution (typically 0.5 × 0.5 × 1-3 mm) 39,45,54,55 . These T2*-weighted images can be post-processed using the susceptibility-weighted imaging (SWI) technique to further enhance venous conspicuity 56 .…”

Section: Statements and Recommendationsmentioning

confidence: 99%

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

et al. 2016

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At present, the diagnosis of multiple sclerosis (MS) relies heavily on the use of MRI, which can demonstrate disease dissemination in space and time [1][2][3][4] . The current 2010 McDonald criteria have enabled earlier diagnosis 5,6 and initiation of disease-modifying treatment, with substantial benefits for disease outcome 7,8 , but they still have imperfect sensitivity and specificity 9,10 . The limited accuracy of the criteria results in challenging cases and misdiagnosis, which are prevalent problems in MS 11,12 . Therefore, more-accurate and pathologically specific MRI criteria are still needed to exclude other disorders that can mimic MS 13,14 .The MRI-detectable central vein inside white matter lesions has recently been proposed as a biomarker of inflammatory demyelination and, thus, may aid the diagnosis of MS 15 . 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. However, the lack of standardization for the definition and imaging of the CVS, as well as a dearth of large-scale prospective studies evaluating the CVS for MS diagnosis, are currently preventing the clinical validation of this potential biomarker 1,23 .This Consensus Statement aims to provide recommendations for the definition, standardization and clinical evaluation of the CVS in the diagnosis of MS. These statements are based on a thorough review of the existing literature on the CVS and the consensus opinion of the members of the North American Imaging in Multiple Sclerosis (NAIMS) Cooperative. E X P E RT C O N S E N S U S D O C U M E N T on behalf of the NAIMS CooperativeAbstract | Over the past few years, MRI has become an indispensable tool for diagnosing multiple sclerosis (MS). However, the current MRI criteria for MS diagnosis have imperfect sensitivity and specificity. The central vein sign (CVS) has recently been proposed as a novel MRI biomarker to improve the accuracy and speed of MS diagnosis. Evidence indicates that the presence of the CVS in individual lesions can accurately differentiate MS from other diseases that mimic this condition. However, the predictive value of the CVS for the development of clinical MS in patients with suspected demyelinating disease is still unknown. Moreover, the lack of standardization for the definition and imaging of the CVS currently limits its clinical implementation and validation. On the basis of a thorough review of the existing literature on the CVS and the consensus opinion of the members of the North American Imaging in Mult...

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“…Collection of multiple echoes within a single TR acquisition does not prolong scan time compared to the time needed to acquire a single echo. 5 Further, SWAN can acquires thin slice 3D images and, as a result, is expected to reduce partial volume averaging. The SWAN approach may be especially useful in evaluating brain tissue likely exposed to large susceptibility diŠer-ences at air-to-soft tissue or bone-to-soft tissue interfaces of the skull base.…”

Section: Discussionmentioning

confidence: 99%

“…However, we believe the paucity of literature means that the diagnostic ability of SWAN has not been determined in comparison with the latter two. 4,5 We aimed to investigate diagnostic ability among these 3 imaging techniques with regard to commonly desired aspects of susceptibility-weighted MR imaging-detection of mineralization and cerebral microbleeds, and depiction of small venous vasculature.…”

Section: Introductionmentioning

confidence: 99%

Clinical Value of 3D T2-weighted Imaging with Multi-echo Acquisition: Comparison with Conventional 2D T2-weighted Imaging and 3D Phase-sensitive MR Imaging

Kunimatsu¹,

Suzuki²,

Hagiwara³

et al. 2012

magn reson med sci

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Susceptibility-weighted angiography (SWAN) is a state-of-the-art 3-dimensional (3D) T 2 *-weighted imaging (T 2 *WI) technique with multiple echo acquisitions, but its clinical utility remains to be determined. We compared the utility of susceptibility-weighting sequences among SWAN, 3D phase-sensitive magnetic resonance (MR) imaging (PSI), and conventional 2-dimensional (2D) T 2 * WI in routine clinical practice. Our results indicate that SWAN can achieve susceptibility weighting more eŠectively than conventional 2D T 2 *WI and as eŠectively as PSI and requires a much shorter scan time than PSI.

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Presence of a central vein within white matter lesions on susceptibility weighted imaging: a specific finding for multiple sclerosis?

Abstract: Our results indicate that the detection of a central vein within a WML should not be considered a specific finding for MS; it is also found in WMLs of other etiologies.

Cited by 51 publications

References 22 publications

“Central vessel sign” on 3T FLAIR* MRI for the differentiation of multiple sclerosis from migraine

“Central vessel sign” on 3T FLAIR* MRI for the differentiation of multiple sclerosis from migraine

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

Clinical Value of 3D T2-weighted Imaging with Multi-echo Acquisition: Comparison with Conventional 2D T2-weighted Imaging and 3D Phase-sensitive MR Imaging

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Presence of a central vein within white matter lesions on susceptibility weighted imaging: a specific finding for multiple sclerosis?

Abstract: Our results indicate that the detection of a central vein within a WML should not be considered a specific finding for MS; it is also found in WMLs of other etiologies.

Cited by 51 publications

References 22 publications

“Central vessel sign” on 3T FLAIR* MRI for the differentiation of multiple sclerosis from migraine

“Central vessel sign” on 3T FLAIR* MRI for the differentiation of multiple sclerosis from migraine

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

Clinical Value of 3D T2*-weighted Imaging with Multi-echo Acquisition: Comparison with Conventional 2D T2*-weighted Imaging and 3D Phase-sensitive MR Imaging

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Clinical Value of 3D T2-weighted Imaging with Multi-echo Acquisition: Comparison with Conventional 2D T2-weighted Imaging and 3D Phase-sensitive MR Imaging