The central vein sign and paramagnetic rim lesions: biomarkers for an accurate differential diagnosis between multiple sclerosis and migraine

This study aimed to assess whether the evaluation of the central vein sign (CVS) and paramagnetic rim lesions (PRLs) using susceptibility-weighted magnetic resonance imaging (MRI) can distinguish multiple sclerosis (MS) from migraine.

In this single-center observational study, we conducted a cross-sectional analysis of the CVS, determining the proportion of CVS-positive lesions per individual and absolute counts, using thresholds of 3 lesions (select3*) and 6 lesions (select6*), and of PRLs in participants with MS and in those with migraine, from 3.0-T MRI brain scans.

The study included 20 participants with MS, 20 with migraine, and 20 included as healthy controls. The proportion of participants with CVS-positive lesions was higher in the MS group than in the migraine group (61.8% vs. 10.4%), and PRLs were observed exclusively in the MS group. The presence of at least one PRL and the select6* criterion demonstrated the highest diagnostic accuracy within the study sample.

The detection of the CVS and of a PRL on 3.0-T MRI scans may serve as a reliable biomarker to differentiate MS from migraine.