central veins in brain lesions as a diagnostic marker

A forum to discuss Chronic Cerebrospinal Venous Insufficiency and its relationship to Multiple Sclerosis.

central veins in brain lesions as a diagnostic marker

Postby Cece » Fri Sep 13, 2013 8:29 pm

http://archneur.jamanetwork.com/article ... F25%2F2013
Central Veins in Brain Lesions Visualized With High-Field Magnetic Resonance Imaging
A Pathologically Specific Diagnostic Biomarker for Inflammatory Demyelination in the Brain

Niraj Mistry, MA; Jennifer Dixon, PhD; Emma Tallantyre, PhD; Christopher Tench, PhD; Rasha Abdel-Fahim, MBBCh; Tim Jaspan, FRCR; Paul S. Morgan, PhD; Peter Morris, PhD; Nikos Evangelou, FRCP
JAMA Neurol. 2013;70(5):623-628. doi:10.1001/jamaneurol.2013.1405. Text Size: A A A

ABSTRACT
ABSTRACT | METHOD | RESULTS | COMMENT | ARTICLE INFORMATION | REFERENCES
Importance There is no single test that is diagnostic for multiple sclerosis (MS), and existing diagnostic criteria are imperfect. This can lead to diagnostic delay. Some patients require multiple (sometimes invasive) investigations, and extensive clinical follow-up to confirm or exclude a diagnosis of MS. A diagnostic biomarker that is pathologically specific for the inflammatory demyelination in MS could overhaul current diagnostic algorithms.

Objective To prospectively assess the diagnostic value of visualizing central veins in brain lesions with magnetic resonance imaging (MRI) for patients with possible MS for whom the diagnosis is uncertain.

Design Prospective longitudinal cohort study. The reference standard is a clinical diagnosis that is arrived at (after a mean follow-up of 26 months) by the treating neurologist with a specialist interest in MS. The 7-T MRI scans were analyzed at baseline, by physicians blinded to the clinical data, for the presence of visible central veins.

Setting Academic MS referral center.

Participants A consecutive sample of 29 patients referred with possible MS who had brain lesions detected on clinical MRI scans but whose condition remained undiagnosed despite expert clinical and radiological assessments.

Exposure Seven-Tesla MRI using a T2*-weighted sequence.

Main Outcomes and Measures The proportion of patients whose condition was correctly diagnosed as MS or as not MS, using 7-T MRI at study onset, compared with the eventual diagnosis reached by treating physicians blinded to the result of the MRI scan.

Results Of the 29 patients enrolled and scanned using 7-T MRI, so far 22 have received a clinical diagnosis. All 13 patients whose condition was eventually diagnosed as MS had central veins visible in the majority of brain lesions at baseline. All 9 patients whose condition was eventually not diagnosed as MS had central veins visible in a minority of lesions.

Conclusions and Relevance In our study, T2*-weighted 7-T MRI had 100% positive and negative predictive value for the diagnosis of MS. Clinical application of this technique could improve existing diagnostic algorithms.

Central veins may be a more reliable marker of MS than the lesions themselves. Count veins not plaques.
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Re: central veins in brain lesions as a diagnostic marker

Postby 1eye » Sat Sep 14, 2013 10:11 am

First of all, isn't 7-T MRI a little overkill for detecting veins? Also, isn't it more important to conclude that the "MS" lesions are associated with veins? And that "MS" may be a symptom of venous pathology?

I took 15 years to get my diagnosis the other way, only to be referred to an "MS" neurologist, who had nothing much to offer but social work, and a fond "adios" once I had been assessed as "SPMS".

Veins are not necessarily the only problem. CSF comes from blood and returns to blood. Aren't the lesions also peri-ventricular? Perhaps the association in space of veins, lesions and CSF ventricles means something. They conclude that periventricular lesions are diagnostic of demyelination. I was not aware you could even see demyelination without a biopsy at least, if not an autopsy. But then, there are many things I am not aware of, so don't ask me.
"Try - Just A Little Bit Harder" - Janis Joplin
CCSVI procedure Albany Aug 2010
'MS' is over - if you want it
Patients sans/without patience
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