The "central vein sign" to differentiate multiple sclerosis from migraine

Area of Science:

• Neuroimaging
• Neurology
• Radiology

Background:

• Differentiating multiple sclerosis (MS) from migraine is clinically important.
• The central vein sign (CVS) is a potential imaging biomarker in MS.
• Understanding the prevalence and distribution of CVS in MS and migraine is crucial.

Purpose of the Study:

• To determine the prevalence of CVS in MS and migraine cohorts.
• To analyze the spatial distribution of CVS-positive (CVS+) lesions.
• To establish a CVS+ lesion threshold for distinguishing MS from migraine.

Main Methods:

• 3-T MRI scans were performed on 70 MS patients and 50 migraine patients.
• CVS was evaluated based on current guidelines.
• Receiver operating characteristic (ROC) curve analysis identified optimal thresholds for differentiating MS from migraine.

Main Results:

• CVS+ lesions were significantly larger and more numerous in MS patients compared to migraine patients.
• A higher proportion of CVS+ lesions correlated with an increased likelihood of MS diagnosis.
• A CVS proportion threshold of 35.0% achieved 97.1% sensitivity and 85.7% specificity in differentiating MS from migraine.

Conclusions:

• A CVS proportion of 35.0% effectively distinguishes MS from migraine with high diagnostic accuracy.
• The "select 6" algorithm may offer improved specificity for clinical application in differentiating these conditions.