Reliability of Central Vein Sign Imaging With 3T FLAIR* in a Multicenter Study

Area of Science:

• Neuroimaging
• Radiology
• Biomarkers

Background:

• The central vein sign (CVS) is a key imaging biomarker for multiple sclerosis (MS).
• FLAIR* MRI at 3 Tesla (3T) offers high conspicuity for detecting CVS.
• Ensuring the reliability of CVS detection across different settings is crucial for clinical application.

Purpose of the Study:

• To evaluate the reliability of 3T FLAIR* for CVS conspicuity across multiple imaging sites and MRI vendors.
• To determine if gadolinium (Gd) contrast enhances CVS conspicuity on 3T FLAIR*.

Main Methods:

• A multicenter study involving 87 adults with suspected MS at nine sites.
• High-resolution T2*-weighted and T2-weighted FLAIR brain images were acquired at 3T from two vendors, pre- and post-Gd contrast.
• Lesion-to-vein contrast-to-noise ratio (CNR_{lesion-to-vein}) was computed to quantify CVS conspicuity.

Main Results:

• No significant differences in mean CNR_{lesion-to-vein} were found between imaging sites or MRI vendors for both pre- and post-Gd FLAIR*.
• A statistically significant increase in CVS conspicuity was observed with post-Gd FLAIR* compared to pre-Gd FLAIR* (p < 0.001).

Conclusions:

• CVS conspicuity using 3T FLAIR* is consistent and reliable across diverse clinical imaging environments and MRI manufacturers.
• Gadolinium contrast agent significantly improves the conspicuity of CVS on 3T FLAIR*.
• These findings advocate for the integration of FLAIR* imaging into routine clinical practice for MS diagnosis.