Omar Al-Louzi1, Sargis Manukyan1, Maxime Donadieu2, Martina Absinta3, Vijay Letchuman2, Brent Calabresi2, Parth Desai4, Erin S Beck5, Snehashis Roy6, Joan Ohayon7, Dzung L Pham8, Anish Thomas4, Steven Jacobson9, Irene Cortese7, Pavan K Auluck10, Govind Nair2, Pascal Sati1, Daniel S Reich2. 1. Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA; Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA. 2. Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA. 3. Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD; USA/IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy. 4. Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA. 5. Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 6. Section on Neural Function, National Institute of Mental Health, Bethesda, MD, USA. 7. Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA. 8. Center for Neuroscience and Regenerative Medicine, The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA. 9. Viral Immunology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA. 10. Human Brain Collection Core, National Institute of Mental Health, Bethesda, MD, USA.
Abstract
BACKGROUND: The "central vein sign" (CVS), a linear hypointensity on T2*-weighted imaging corresponding to a central vein/venule, is associated with multiple sclerosis (MS) lesions. The effect of lesion-size exclusion criteria on MS diagnostic accuracy has not been extensively studied. OBJECTIVE: Investigate the optimal lesion-size exclusion criteria for CVS use in MS diagnosis. METHODS: Cross-sectional study of 163 MS and 51 non-MS, and radiological/histopathological correlation of 5 MS and 1 control autopsy cases. The effects of lesion-size exclusion on MS diagnosis using the CVS, and intralesional vein detection on histopathology were evaluated. RESULTS: CVS+ lesions were larger compared to CVS- lesions, with effect modification by MS diagnosis (mean difference +7.7 mm3, p = 0.004). CVS percentage-based criteria with no lesion-size exclusion showed the highest diagnostic accuracy in differentiating MS cases. However, a simple count of three or more CVS+ lesions greater than 3.5 mm is highly accurate and can be rapidly implemented (sensitivity 93%; specificity 88%). On magnetic resonance imaging (MRI)-histopathological correlation, the CVS had high specificity for identifying intralesional veins (0/7 false positives). CONCLUSION: Lesion-size measures add important information when using CVS+ lesion counts for MS diagnosis. The CVS is a specific biomarker corresponding to intralesional veins on histopathology.
BACKGROUND: The "central vein sign" (CVS), a linear hypointensity on T2*-weighted imaging corresponding to a central vein/venule, is associated with multiple sclerosis (MS) lesions. The effect of lesion-size exclusion criteria on MS diagnostic accuracy has not been extensively studied. OBJECTIVE: Investigate the optimal lesion-size exclusion criteria for CVS use in MS diagnosis. METHODS: Cross-sectional study of 163 MS and 51 non-MS, and radiological/histopathological correlation of 5 MS and 1 control autopsy cases. The effects of lesion-size exclusion on MS diagnosis using the CVS, and intralesional vein detection on histopathology were evaluated. RESULTS: CVS+ lesions were larger compared to CVS- lesions, with effect modification by MS diagnosis (mean difference +7.7 mm3, p = 0.004). CVS percentage-based criteria with no lesion-size exclusion showed the highest diagnostic accuracy in differentiating MS cases. However, a simple count of three or more CVS+ lesions greater than 3.5 mm is highly accurate and can be rapidly implemented (sensitivity 93%; specificity 88%). On magnetic resonance imaging (MRI)-histopathological correlation, the CVS had high specificity for identifying intralesional veins (0/7 false positives). CONCLUSION: Lesion-size measures add important information when using CVS+ lesion counts for MS diagnosis. The CVS is a specific biomarker corresponding to intralesional veins on histopathology.
Entities:
Keywords:
Biomarkers; T2 lesions; central vein sign; magnetic resonance imaging; multiple sclerosis; post mortem
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