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Updated: Dec 20, 2025
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Value of 3T Susceptibility-Weighted Imaging in the Diagnosis of Multiple Sclerosis
M A Clarke1, D Pareto1,2, L Pessini-Ferreira2
1From the Vall d'Hebron Research Institute (M.A.C., D.P., M.A., M.T., J.S.-G., C.A., X.M., A.R.), Barcelona, Spain.
Background And Purpose:
Previous studies have suggested that the central vein sign and iron rims are specific features of MS lesions. Using 3T SWI, we aimed to compare the frequency of lesions with central veins and iron rims in patients with clinically isolated syndrome and MS-mimicking disorders and test their diagnostic value in predicting conversion from clinically isolated syndrome to MS.
Materials And Methods:
For each patient, we calculated the number of brain lesions with central veins and iron rims. We then identified a simple rule involving an absolute number of lesions with central veins and iron rims to predict conversion from clinically isolated syndrome to MS. Additionally, we tested the diagnostic performance of central veins and iron rims when combined with evidence of dissemination in space.
Results:
We included 112 patients with clinically isolated syndrome and 35 patients with MS-mimicking conditions. At follow-up, 94 patients with clinically isolated syndrome developed MS according to the 2017 McDonald criteria. Patients with clinically isolated syndrome had a median of 2 central veins (range, 0-19), while the non-MS group had a median of 1 central vein (range, 0-6). Fifty-six percent of patients who developed MS had ≥1 iron rim, and none of the patients without MS had iron rims. The sensitivity and specificity of finding ≥3 central veins and/or ≥1 iron rim were 70% and 86%, respectively. In combination with evidence of dissemination in space, the 2 imaging markers had higher specificity than dissemination in space and positive findings of oligoclonal bands currently used to support the diagnosis of MS.
Conclusions:
A single 3T SWI scan offers valuable diagnostic information, which has the potential to prevent MS misdiagnosis.
Insights
The central vein sign and iron rims in brain lesions are valuable imaging markers. These features, identified via 3T SWI, can help predict conversion from clinically isolated syndrome to multiple sclerosis (MS).
Area of Science:
- Neuroimaging
- Radiology
- Neurology
Background:
- The central vein sign and iron rims are proposed specific imaging markers for multiple sclerosis (MS) lesions.
- Distinguishing MS from MS-mimicking disorders and predicting conversion from clinically isolated syndrome (CIS) to MS remain diagnostic challenges.
Purpose of the Study:
- To compare the frequency of lesions with central veins and iron rims in CIS and MS-mimicking conditions using 3T SWI.
- To evaluate the diagnostic value of these imaging markers in predicting CIS conversion to MS.
Main Methods:
- 112 patients with CIS and 35 with MS-mimicking conditions underwent 3T SWI.
- The number of brain lesions with central veins and iron rims was quantified for each patient.
- A predictive rule for CIS conversion to MS was developed and tested, including combinations with dissemination in space.
Main Results:
- Of 112 CIS patients, 94 converted to MS. Patients who developed MS had a median of 2 central veins vs. 1 in the non-MS group.
- 56% of MS converters had ≥1 iron rim, absent in non-MS patients. Sensitivity/specificity for ≥3 central veins and/or ≥1 iron rim were 70%/86%.
- Combined with dissemination in space, these markers showed higher specificity than current diagnostic criteria.
Conclusions:
- A single 3T SWI scan provides significant diagnostic information for MS.
- The central vein sign and iron rims show potential to improve diagnostic accuracy and prevent misdiagnosis of MS.
