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The Central Vein Sign in Radiologically Isolated Syndrome.

S Suthiphosuwan1,2, P Sati3, M Guenette2

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Most radiologically isolated syndrome cases show a high proportion of central vein sign lesions, indicating inflammatory demyelination. This finding suggests the central vein sign may help predict progression to multiple sclerosis.

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Area of Science:

  • Neurology
  • Radiology
  • Immunology

Background:

  • Radiologically isolated syndrome (RIS) involves asymptomatic individuals with MRI abnormalities suggesting multiple sclerosis.
  • The central vein sign (CVS) on MRI, indicating perivenous inflammation, is present in over 40% of multiple sclerosis (MS) white matter lesions.
  • CVS aids in differentiating MS from other white matter disorders.

Purpose of the Study:

  • To investigate the prevalence of the central vein sign in white matter lesions of individuals with radiologically isolated syndrome.
  • To determine if the central vein sign can differentiate RIS from other white matter pathologies.

Main Methods:

  • 20 participants with radiologically isolated syndrome underwent 3T MRI of the brain and cervical spinal cord.
  • White matter lesions were analyzed for the presence of the central vein sign.

Main Results:

  • 75% of 391 white matter lesions exhibited the central vein sign (CVS+).
  • 90% of participants had ≥40% CVS+ lesions, aligning with criteria for MS.
  • The proportion of CVS+ lesions correlated with spinal cord and infratentorial lesion load.

Conclusions:

  • The high prevalence of CVS+ lesions in RIS suggests perivenous inflammatory demyelination.
  • CVS may hold prognostic value in identifying RIS patients at risk for developing clinical MS.
  • Further prospective studies are warranted to confirm the prognostic utility of the central vein sign in RIS.