Lesion size and shape in central vein sign assessment for multiple sclerosis diagnosis: An in vivo and postmortem MRI study. (October 2022)

• Record Type: Journal Article
• Authors: Al-Louzi, Omar; Manukyan, Sargis; Donadieu, Maxime; Absinta, Martina; Letchuman, Vijay; Calabresi, Brent; Desai, Parth; Beck, Erin S; Roy, Snehashis; Ohayon, Joan; Pham, Dzung L; Thomas, Anish; Jacobson, Steven; Cortese, Irene; Auluck, Pavan K; Nair, Govind; Sati, Pascal; Reich, Daniel S
• Is Part Of: Multiple sclerosis. Volume 28:Number 12(2022)
• Page Start: 1891
• Page End: 1902
• Publication Date: 2022-10
• Subjects: Biomarkers -- multiple sclerosis -- magnetic resonance imaging -- post mortem -- T2 lesions -- central vein sign; Central nervous system -- Diseases -- Periodicals; Myelin sheath -- Diseases -- Periodicals; Inflammation -- Periodicals; Multiple sclerosis -- Periodicals; Central Nervous System Diseases -- Periodicals; Demyelinating Diseases -- Periodicals; Inflammation -- Periodicals; Multiple Sclerosis -- Periodicals; Système nerveux central -- Maladies -- Périodiques; Gaine de myéline -- Maladies -- Périodiques; Inflammation (Pathologie) -- Périodiques; Sclérose en plaques -- Périodiques; Electronic journals; 616.834005
• DOI: 10.1177/13524585221097560
• Languages: English
• ISSNs: 1352-4585

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 mm 3, 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.