Central vein sign for multiple sclerosis: A systematic review and meta-analysis. Issue 6 (June 2020)

• Record Type: Journal Article
• Authors: Bhandari, A.; Xiang, H.; Lechner-Scott, J.; Agzarian, M.
• Is Part Of: Clinical radiology. Volume 75:Issue 6(2020)
• Page Start: 479.e9
• Page End: 479.e15
• Publication Date: 2020-06
• Subjects: Medical radiology -- Periodicals; Radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiology -- Periodicals; Societies, Medical -- Periodicals; Medical radiology; Radiotherapy; Electronic journals; Periodicals; 616.0757
• DOI: 10.1016/j.crad.2020.01.011
• Languages: English
• ISSNs: 0009-9260

Abstract

Abstract : AIMS: To systematically review the diagnostic value of the central vein sign (CVS) in multiple sclerosis (MS) and to meta-analyse the proportion of positive lesions for CVS needed to distinguish MS from non-MS mimics. MATERIALS AND METHODS: A literature review was performed and a proportion meta-analysis was performed to examine the proportion of the CVS in MS lesions. Studies reporting a threshold of the CVS containing lesions with 100% diagnostic accuracy were included in the meta-analysis. This was compared to MS mimics in order to establish the discriminative value of the CVS. RESULTS: The CVS was found to be viable at lower field strengths (3 T and 1.5 T) and automated analysis is currently less accurate than manual counting. Five studies were included for the proportional meta-analysis. From the analysis, a proportion of 45% of lesions having the CVS was suggested given that the findings that the weighted proportion was 46.4% (95% confidence interval [CI]: of 40.3%–52.6%) with low heterogeneity (I 2 = 0.0%; p =0.5). CONCLUSION: Although the CVS is a clinically relevant and viable sign, further work is needed to integrate this into the existing diagnostic criteria. As manual determination is a time-consuming process, the development of automated methods will be beneficial. With improvements in computational imaging techniques, the CVS will have an important role in the diagnosis and differentiation of MS. Highlights: Some Multiple Sclerosis (MS) plaques have been shown to have an association with a central vein. This can be qualitatively examined via magnetic resonance imaging and this is termed the central vein sign (CVS). CVS has been proposed as a marker for differentiation from non-MS mimics. A threshold of 45% of MS lesions containing this sign for differentiation from radiological mimics is suggested. Continued Research on automated analysis is needed for integration into clinical practice due to the time-consuming nature of manual counting.