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

Area of Science:

• Neurology
• Radiology
• Immunology

Background:

• Magnetic resonance imaging (MRI) aids in detecting white matter lesions in multiple sclerosis (MS), but specificity remains a challenge.
• The central vein sign, indicating perivenular lesions, enhances the pathological specificity of MS diagnosis.
• Comprehensive evaluation of the central vein sign in MS-mimicking inflammatory diseases is lacking.

Purpose of the Study:

• To assess the frequency of perivenular lesions in MS versus central nervous system (CNS) inflammatory vasculopathies.
• To evaluate the diagnostic accuracy of the central vein sign in differentiating MS from these mimics.

Main Methods:

• A multicenter study involving 52 patients with relapsing-remitting MS and 31 with inflammatory CNS vasculopathies.
• Acquisition of 3D T2*-weighted and T2-fluid-attenuated inversion recovery MRI scans after gadolinium injection.
• Evaluation of the central vein sign, lesion counts, volume, location, and dissemination in space criteria.

Main Results:

• Multiple sclerosis (MS) exhibited a significantly higher frequency of perivenular lesions (median 88%) compared to inflammatory CNS vasculopathies (14%).
• No overlap in perivenular lesion frequency was observed between MS and inflammatory vasculopathies.
• Applying a 50% threshold for the central vein sign achieved 100% diagnostic accuracy in differentiating MS from inflammatory vasculopathies.

Conclusions:

• The central vein sign is a reliable MRI biomarker for distinguishing MS from inflammatory CNS vasculopathies.
• This sign demonstrates high diagnostic accuracy at standard clinical magnetic field strengths (1.5T and 3T).
• The central vein sign improves diagnostic specificity in ambiguous cases often encountered in clinical practice.