Comparative performance of 7T MRI sequences for central vein sign detection in multiple sclerosis: a prospective...

The central vein sign (CVS) has been incorporated into the 2024 McDonald criteria for multiple sclerosis (MS) diagnosis. However, the optimal MRI sequence for detecting CVS at 7T remains unclear due to limited direct comparisons. This study aimed to perform a head-to-head comparison of gradient-recalled echo (GRE T2*), susceptibility-weighted imaging (SWI), and 3D echo-planar imaging (3D EPI T2*) sequences for CVS detection in MS patients using 7T MRI.

20 participants with MS were prospectively recruited from the Chinese National Registry of Neuroinflammatory Diseases (CNRID) and scanned on a 7T MRI scanner using three sequences. CVS-positive lesions were independently assessed by two blinded raters. Lesion-level detection rates and inter-/intra-rater reliability were evaluated using the Friedman test and Cohen's kappa.

A total of 1411 MS lesions were analyzed. No significant differences were found in CVS detection rates across the three sequences (GRE T2*: 780; SWI: 771; 3D EPI T2*: 777; P = 0.082). All sequences showed excellent inter-rater (κ ≥ 0.935) and intra-rater (κ ≥ 0.961) agreement. Slightly lower detection with 3D EPI T2* was attributed to resolution limitations, while SWI missed lesions mainly due to insufficient tissue contrast.

Our study indicates that conventional, widely available GRE T2* and SWI perform comparably to 3D EPI T2* for CVS detection at 7T MRI.