Evaluating the central vein sign in paediatric-onset multiple sclerosis: A case series study

Diagnosing multiple sclerosis in children presents unique challenges due to overlapping symptoms with other neurological conditions. Prior research has shown that the central vein sign may help distinguish MS from other diseases in adults. However, no prior work had resolved whether this sign performs similarly in pediatric cases. The diagnostic accuracy of the central vein sign remains unclear in pediatric-onset multiple sclerosis. Establishing reliable biomarkers is essential for early and accurate diagnosis in this population. Current diagnostic criteria rely on clinical and radiological features, but they may lack specificity in children. The central vein sign has not been systematically evaluated in pediatric-onset MS. This gap motivated the current study to assess the utility of the central vein sign in this specific group. The need for improved diagnostic tools in pediatric neurology remains unmet.

This study aimed to evaluate the diagnostic contribution of the central vein sign in pediatric-onset multiple sclerosis. The researchers focused on comparing the central vein sign's performance between pediatric and adult-onset MS patients. They selected 10 pediatric and 12 adult-onset MS cases with matched disease duration. The goal was to determine if the central vein sign could reliably identify MS in children. The study also sought to explore factors that might affect the sign's accuracy in this population. The researchers hypothesized that the central vein sign might have reduced sensitivity in pediatric-onset MS. The motivation stemmed from the lack of pediatric-specific biomarker validation. The study aimed to address this unmet need in clinical practice.

The researchers conducted a case series study involving 10 pediatric-onset and 12 adult-onset multiple sclerosis patients. All participants had similar disease durations to ensure comparability. The central vein sign was assessed using MRI scans of the brain. Lesions were evaluated for the presence of the central vein sign. The 40%-threshold was used to determine positivity for the sign. The study excluded periventricular confluent lesions from the analysis. The researchers compared the proportion of central vein sign-positive lesions between the two groups. The study design allowed for a focused evaluation of the sign's diagnostic utility in children.

Three out of 10 pediatric-onset MS patients did not meet the 40%-threshold for central vein sign-positive lesions. In contrast, all 12 adult-onset MS patients met the threshold. The central vein sign showed lower sensitivity in the pediatric group. The presence of periventricular confluent lesions appeared to affect the sign's accuracy. These lesions were excluded from the analysis, potentially reducing the number of evaluable lesions. The study found no significant difference in lesion distribution between the groups. The central vein sign's diagnostic accuracy was higher in adult-onset MS. The findings suggest that the sign may not be as reliable in pediatric-onset cases.

The central vein sign may have reduced sensitivity in diagnosing pediatric-onset multiple sclerosis. The high proportion of periventricular confluent lesions in children may limit the sign's utility. The study found that three pediatric cases did not meet the 40%-threshold for positivity. The researchers propose that this may be due to the exclusion of confluent lesions from the analysis. The findings suggest that the central vein sign may not be a reliable biomarker in this population. The study did not find evidence of higher specificity in pediatric-onset MS. The authors suggest that further research is needed to validate alternative biomarkers. The current results highlight the need for pediatric-specific diagnostic criteria.