Diagnostic performance of central vein sign, paramagnetic rim lesion and cortical lesion in Asian patients with...

The 2024 revised McDonald criteria for multiple sclerosis (MS) incorporate central vein sign (CVS) and paramagnetic rim lesion (PRL), but their utility in Asian patients remains unclear.

To evaluate the performance of CVS, PRL and cortical lesion (CL) in distinguishing MS from neuromyelitis optica spectrum disorders (NMOSD) and myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD) in Japanese patients.

We conducted a cross-sectional study of 139 MS, 41 NMOSD and 12 MOGAD patients who underwent 3-Tesla magnetic resonance imaging (MRI), including susceptibility-weighted imaging.

At least one CVS was identified in 95% of MS, 59% of NMOSD and 42% of MOGAD, while PRL occurred in 63% of MS only. The CVS number (cutoff ⩾ 2) yielded 85.6% sensitivity and 75.5% specificity (area under the curve (AUC) 0.856), which improved in patients <50 (AUC 0.920) or <70 years (AUC 0.907), and when combined with PRL and CL (AUC 0.926). The Select 6 algorithm achieved 69.1% sensitivity and 98.1% specificity (AUC 0.836), which were comparable in patients <50 (AUC 0.879) or <70 years (AUC 0.839), but improved when combined with PRL and CL (AUC 0.925).

Combining Select 6 or CVS number with PRL and CL, particularly in patients <50 or <70 years, provides robust diagnostic performance for MS in the Asian population.