Related Experiment Video
Updated: Aug 24, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Central vein sign and paramagnetic rim lesions in pediatric-onset multiple sclerosis: a systematic review and
Anna de Mauro1,2, Rosa Cortese1,2,3,4,5, Giulia Fadda6
1Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland.
Background:
Susceptibility-based MRI biomarkers, including paramagnetic rim lesions (PRLs) and central vein sign (CVS), were incorporated into the 2024 McDonald criteria because they improve diagnostic specificity in adult-onset MS; however, their role in pediatric-onset MS (POMS) remains incompletely defined.
Objective:
To synthesize current evidence on the prevalence and diagnostic value of PRLs and CVS in POMS.
Methods:
We conducted a PRISMA-compliant systematic review and random-effects meta-analysis of studies reporting PRLs and/or CVS in POMS. Outcomes included the proportion of patients with ≥1 PRL, the mean proportion of CVS-positive lesions, and fulfillment of CVS-based thresholds.
Results:
Eleven studies were included. Across seven studies, the pooled proportion of POMS patients with ≥1 PRL was 71.6% (95% CI 61.1-80.2; n=149), with low between-study heterogeneity. Across six studies, the pooled mean proportion of CVS-positive lesions was 57.9% (95% CI 39.7-76.2; n=99), and 66.2% (95% CI 10.5-97.0; n=219) of patients fulfilled the 40%-CVS rule, with substantial variability across studies. In comparative analyses, PRLs showed high specificity for POMS, while CVS was more prevalent than in mimics; however, limited data precluded quantitative evaluation.
Conclusion:
PRLs are frequent in POMS. Limited comparative data suggest that PRLs may have high diagnostic specificity, whereas CVS appears more variable; however, pediatric diagnostic accuracy evidence remains scarce. Further pediatric-specific studies are needed to define the optimal diagnostic use of these biomarkers in POMS.
Insights
Paramagnetic rim lesions (PRLs) are common in pediatric-onset multiple sclerosis (POMS), showing high diagnostic specificity. Central vein sign (CVS) is variable, and more pediatric-specific research is needed for accurate diagnosis.
Area of Science:
- Neurology
- Radiology
- Pediatric Medicine
Background:
- Susceptibility-based MRI biomarkers like paramagnetic rim lesions (PRLs) and central vein sign (CVS) are key in adult MS diagnosis.
- Their diagnostic utility in pediatric-onset MS (POMS) requires further definition.
Purpose of the Study:
- To systematically review and meta-analyze the prevalence and diagnostic value of PRLs and CVS in POMS.
- To synthesize current evidence on these MRI biomarkers in pediatric MS patients.
Main Methods:
- Conducted a PRISMA-compliant systematic review and random-effects meta-analysis.
- Analyzed data from 11 studies on PRLs and CVS in POMS.
- Assessed the proportion of patients with PRLs and CVS-positive lesions, and CVS threshold fulfillment.
Main Results:
- Pooled prevalence of ≥1 PRL in POMS was 71.6% with low heterogeneity.
- Pooled mean proportion of CVS-positive lesions was 57.9%, with 66.2% of patients meeting the 40%-CVS rule, showing substantial variability.
- PRLs demonstrated high specificity for POMS; CVS was more prevalent in POMS than mimics, but data were limited.
Conclusions:
- PRLs are frequent in POMS and may possess high diagnostic specificity.
- CVS prevalence is variable in POMS, and current evidence for diagnostic accuracy in pediatrics is scarce.
- Further pediatric-specific studies are essential to establish optimal diagnostic use of these MRI biomarkers in POMS.
Related Concept Videos
01:19Multiple Sclerosis l: Introduction
01:20Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies