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Neuroradiology. 2010 Jun 29. [Epub ahead of print]

Presence of a central vein within white matter lesions on susceptibility weighted imaging: a specific finding for multiple sclerosis?

Lummel N, Boeckh-Behrens T, Schoepf V, Burke M, Brückmann H, Linn J.

Department of Neuroradiology, University of Munich, Marchioninistrasse 15, 81377, Munich, Germany, nina.lummel@med.uni-muenchen.de.

Abstract
INTRODUCTION: Susceptibility weighted imaging depicts the perivenous extent of multiple sclerosis white matter lesions (MS-WML) in vivo by directly visualizing their centrally running vein. The aim of this study was to investigate the specificity of this finding for MS. METHODS: Fifteen patients with MS and 15 patients with microangiopathic white matter lesions (mWML) underwent 3T MRI, including a fluid-attenuated inversion recovery sequence (FLAIR) and a susceptibility weighted angiography (SWAN). All WMLs were identified on FLAIR and assigned to one of the following localizations: supratentorial peripheral, supratentorial periventricular, or infratentorial. Subsequently, the presence of a central vein within these lesions was assessed on SWAN.

RESULTS: A total of 711 MS-WMLs and 1,119 m-WMLs were identified on FLAIR, all of which could also be visualized on SWAN. A central vein was detectable in 80% of the MS-WMLs and in 78% of the m-WMLs (in 73% and 76% of the peripheral, in 92% and 94% of the periventricular, and in 71% and 75% of the infratentorial MS-WMLs and m-WMLs, respectively). With regard to the supratentorial peripheral lesions, significantly more m-WMLs showed a central vein compared to the MS-WMLs. For the other localizations, there was no significant difference between the groups with regard to the percentage of lesions with central vein.

CONCLUSIONS: Our results indicate that the detection of a central vein within a WML should not be considered a specific finding for MS; it is also found in WMLs of other etiologies.

PMID: 20585764 [PubMed - as supplied by publisher]

Before I run out and buy a copy from the newsstand, what are these other etiologies and how do they know anything is specific to the etiology of MS or not when they don't know what the etiology of MS is? Or are they assuming the etiology of MS *is* CCSVI? If so, yahoo!

1eye wrote:Before I run out and buy a copy from the newsstand, what are these other etiologies and how do they know anything is specific to the etiology of MS or not when they don't know what the etiology of MS is? Or are they assuming the etiology of MS *is* CCSVI? If so, yahoo!

That is an excellent point, 1eye.

I looked up "microangiopathic white matter lesions" which is the group the MS lesions were compared to, and it leads me to a paper describing small vessel disease to be of "ischemic" origin.

http://www.springerlink.com/content/v36337l8tj364738/

"Ischemia" = "A decrease in the blood supply to a bodily organ, tissue, or part caused by constriction or obstruction of the blood vessels"

eric593 wrote:

1eye wrote:Before I run out and buy a copy from the newsstand, what are these other etiologies and how do they know anything is specific to the etiology of MS or not when they don't know what the etiology of MS is? Or are they assuming the etiology of MS *is* CCSVI? If so, yahoo!

That is an excellent point, 1eye.

I looked up "microangiopathic white matter lesions" which is the group the MS lesions were compared to, and it leads me to a paper describing small vessel disease to be of "ischemic" origin.

http://www.springerlink.com/content/v36337l8tj364738/

"Ischemia" = "A decrease in the blood supply to a bodily organ, tissue, or part caused by constriction or obstruction of the blood vessels"

Correct me if I am mistaken, but, are they saying that vein-surrounded lesions are not MS-specific because that is a shared feature with vascular problems?

If this is what they are saying, this paper is an additional support to the CCSVI hypothesis.

Just for the sake of a little more clarity,

"Ischemia" = "A decrease in the blood supply to a bodily organ, tissue, or part caused by constriction or obstruction of the blood vessels"

in the case of the brain means a stroke. It does not have to be a devastating incident. Transient Ischemic Attacks (TIA) can be minimal in scope and their effects may last only a few minutes. They are however often considered to be possible precursers of the 'big one'.

ahhhaha
funny people
... and who said that venocentric lesions only apply for MS? its more like a supportive study

alex

the radiologist's report on my brain MRI, which found numerous lesions, concluded that could be microvascular disease, could be demyelinating disease--

a neighbor of my mom's had an MS diagnosis for many years before they said nope, he actually had mutliple strawberry angiomas in his brain, not Multiple Sclerosis.

Which of course are vascular ... and have a correlation with MS:

http://cds.ismrm.org/ismrm-2004/Files/001503.pdf

eric593 wrote:A central vein was detectable in 80% of the MS-WMLs and in 78% of the m-WMLs (in 73% and 76% of the peripheral, in 92% and 94% of the periventricular, and in 71% and 75% of the infratentorial MS-WMLs and m-WMLs, respectively).

At first glance I thought this was anti-ccsvi but on closer read I too see it going both ways. 80% of MS lesions have a central vein...which is the vast majority...but what do the other 20% look like? Are the still near a vein, even if it's not central? These percentages are strikingly similar between MS and nonMS lesions as they go from periventricular to peripheral to infratentorial, that says to me that both conditions have much in common, and the other condition is a vascular-originated WML. Thanks for posting this, eric593, yet another good find.

zap wrote:a neighbor of my mom's had an MS diagnosis for many years before they said nope, he actually had mutliple strawberry angiomas in his brain, not Multiple Sclerosis.

Which of course are vascular ... and have a correlation with MS:

http://cds.ismrm.org/ismrm-2004/Files/001503.pdf

Good find, zap. Interesting that Dr. Traboulsee was one of the authors of that paper back in 2004 which points to venous abnormalities in PwMS. Yet, he is on record as dismissing CCSVI theory (even though he wanted [and received] funds to study it).

Cece - yes, I agree, I think the fact that both MS lesions and lesions created by ischemic events both have veins running through them is positive information because it shows the similarities between our own lesions and those created by blood flow problems.