Rosa Cortese1, Lise Magnollay2, Carmen Tur2, Khaled Abdel-Aziz2, Anu Jacob2, Floriana De Angelis2, Marios C Yiannakas2, Ferran Prados2, Sebastien Ourselin2, Tarek A Yousry2, Frederik Barkhof2, Olga Ciccarelli2. 1. From the NMR Research Unit (R.C., L.M., C.T., F.D., M.C.Y., F.P., F.B., O.C.), Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London; NMO Clinical Service at the Walton Centre (K.A.-A., A.J.), Liverpool; Translational Imaging Group (F.P., S.O., F.B.), Centre for Medical Image Computing (CMIC), Department of Medical Physics and Bioengineering, University College London; Lysholm Department of Neuroradiology (T.A.Y.), National Hospital for Neurology and Neurosurgery, London, UK; Department of Radiology and Nuclear Medicine (F.B.), MS Centre Amsterdam, VU Medical Centre Amsterdam, the Netherlands; and National Institute for Health Research (NIHR) (T.A.Y., F.B., O.C.), University College London Hospitals (UCLH) Biomedical Research Centre, London, UK. r.cortese@ucl.ac.uk. 2. From the NMR Research Unit (R.C., L.M., C.T., F.D., M.C.Y., F.P., F.B., O.C.), Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London; NMO Clinical Service at the Walton Centre (K.A.-A., A.J.), Liverpool; Translational Imaging Group (F.P., S.O., F.B.), Centre for Medical Image Computing (CMIC), Department of Medical Physics and Bioengineering, University College London; Lysholm Department of Neuroradiology (T.A.Y.), National Hospital for Neurology and Neurosurgery, London, UK; Department of Radiology and Nuclear Medicine (F.B.), MS Centre Amsterdam, VU Medical Centre Amsterdam, the Netherlands; and National Institute for Health Research (NIHR) (T.A.Y., F.B., O.C.), University College London Hospitals (UCLH) Biomedical Research Centre, London, UK.
Abstract
OBJECTIVE: To assess the value of the central vein sign (CVS) on a clinical 3T scanner to distinguish between multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). METHODS: Eighteen aquaporin-4-antibody-positive patients with NMOSD, 18 patients with relapsing-remitting MS, and 25 healthy controls underwent 3T MRI. The presence of a central vein in white matter lesions on susceptibility-weighted imaging, defined as a thin hypointense line or a small dot, was recorded. RESULTS: The proportion of lesions with the CVS was higher in MS than NMOSD (80% vs 32%, p < 0.001). A greater proportion of lesions with the CVS predicted the diagnosis of MS, rather than NMOSD (odds ratio 1.10, 95% confidence interval [CI] 1.04 to 1.16, p = 0.001), suggesting that each percent unit increase in the proportion of lesions with the CVS in an individual patient was associated with a 10% increase in the risk of the same patient having MS. If more than 54% of the lesions on any given scan show the CVS, then the patient can be given a diagnosis of MS with an accuracy of 94% (95% CIs 81.34, 99.32, p < 0.001, sensitivity/specificity 90%/100%). CONCLUSION: The clinical value of the CVS in the context of the differential diagnosis between MS and NMOSD, previously suggested using 7T scanners, is now extended to clinical 3T scanners, thereby making a step towards the use of CVS in clinical practice. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that the CVS on 3T MRI accurately distinguishes patients with MS from those with seropositive NMOSD.
OBJECTIVE: To assess the value of the central vein sign (CVS) on a clinical 3T scanner to distinguish between multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). METHODS: Eighteen aquaporin-4-antibody-positive patients with NMOSD, 18 patients with relapsing-remitting MS, and 25 healthy controls underwent 3T MRI. The presence of a central vein in white matter lesions on susceptibility-weighted imaging, defined as a thin hypointense line or a small dot, was recorded. RESULTS: The proportion of lesions with the CVS was higher in MS than NMOSD (80% vs 32%, p < 0.001). A greater proportion of lesions with the CVS predicted the diagnosis of MS, rather than NMOSD (odds ratio 1.10, 95% confidence interval [CI] 1.04 to 1.16, p = 0.001), suggesting that each percent unit increase in the proportion of lesions with the CVS in an individual patient was associated with a 10% increase in the risk of the same patient having MS. If more than 54% of the lesions on any given scan show the CVS, then the patient can be given a diagnosis of MS with an accuracy of 94% (95% CIs 81.34, 99.32, p < 0.001, sensitivity/specificity 90%/100%). CONCLUSION: The clinical value of the CVS in the context of the differential diagnosis between MS and NMOSD, previously suggested using 7T scanners, is now extended to clinical 3T scanners, thereby making a step towards the use of CVS in clinical practice. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that the CVS on 3T MRI accurately distinguishes patients with MS from those with seropositive NMOSD.
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