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Updated: Sep 13, 2025
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Central vein sign and paramagnetic rim lesion abbreviated counting methods for diagnosis of multiple sclerosis: a
K Toljan1, M Amin1, D Ontaneda1
1Mellen Center for Multiple Sclerosis Treatment and Research, Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States.
Aim:
The central vein sign (CVS) and paramagnetic rim lesion (PRL) are neuroimaging biomarkers in multiple sclerosis (MS). Abbreviated CVS methods are an alternative to percentage-based approaches. The pooled diagnostic performance of Select-3 (≥3 CVS + lesions), Select-6 (≥6 CVS + lesions), and PRL (≥1 lesion) is unknown. To summarise the diagnostic performance of CVS and PRL abbreviated methods forMS.
Materials And Methods:
We conducted a systematic review and meta-analysis for studies that included two common abbreviated CVS methods (Select-3, Select-6), and/or ≥1 PRL. The search was conducted in PubMed, Scopus, and Web of Science. Studies were included if the sample consisted of participants with MS and controls, and if the diagnostic performance of CVS and/or PRL was extractable. Quality was determined according to the QUADAS-2 tool. Meta-analysis was performed with a hierarchical model. Prespecified sensitivity analyses were conducted. Publication bias was assessed with Deeks' plot.
Resuts:
Twenty-nine studies were included. Select-3 was available in 14 studies, Select-6 in 12 studies, and PRL in 17 studies. For Select-3, pooled sensitivity was 0.88 (0.79-0.94) and specificity was 0.77 (0.65-0.86), for Select-6 0.82 (0.70-0.89) and 0.89 (0.82-0.94), and for ≥1 PRL 0.56 (0.42-0.69) and 0.99 (0.95-1.00). Quality was impacted by risk of bias due to patient selection (10/15 CVS studies, 15/17 PRL studies).
Conclusion:
Select-6 and PRL are specific for MS, while Select-3 is sensitive. To improve the quality of findings, future studies should include strategies to avoid selection bias.
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