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Updated: Jan 19, 2026

A Multicenter MRI Protocol for the Evaluation and Quantification of Deep Vein Thrombosis
Published on: June 2, 2015
The "central vein sign" in patients with diagnostic "red flags" for multiple sclerosis: A prospective multicenter 3T
Pietro Maggi1, Martina Absinta2, Pascal Sati3
1Department of Neurology, Center of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland/ Department of Neurology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
Background:
The central vein sign (CVS) has been shown to help in the differential diagnosis of multiple sclerosis (MS), but most prior studies are retrospective.
Objectives:
To prospectively assess the diagnostic predictive value of the CVS in diagnostically difficult cases.
Methods:
In this prospective multicenter study, 51 patients with suspected MS who had clinical, imaging, or laboratory "red flags" (i.e. features atypical for MS) underwent 3T fluid-attenuated inversion recovery (FLAIR*) magnetic resonance imaging (MRI) for CVS assessment. After the diagnostic work-up, expert clinicians blinded to the results of the CVS assessment came to a clinical diagnosis. The value of the CVS to prospectively predict an MS diagnosis was assessed.
Results:
Of the 39 patients who received a clinical diagnosis by the end of the study, 27 had MS and 12 received a non-MS diagnosis that included systemic lupus erythematosus, sarcoidosis, migraine, Sjögren disease, SPG4-spastic-paraparesis, neuromyelitis optica, and Susac syndrome. The percentage of perivenular lesions was higher in MS (median = 86%) compared to non-MS (median = 21%; p < 0.0001) patients. A 40% perivenular lesion cutoff was associated with 97% accuracy and a 96% positive/100% negative predictive value.
Conclusion:
The CVS detected on 3T FLAIR* images can accurately predict an MS diagnosis in patients suspected to have MS, but with atypical clinical, laboratory, and imaging features.
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