Central Vein Sign on SWI is special in MS

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The Central Vein Sign on SWI at 3T MRI Differentiates Multiple Sclerosis from Neuromyelitis Optica

http://www.neurology.org/content/86/16_ ... .147.short


Abstract

OBJECTIVE: To assess the discriminatory value of the central vein sign (CVS) on susceptibility-weighted imaging (SWI) acquired on a clinical scanner (3T) between neuromyelitis optica spectrum disorders (NMOSD) and multiple sclerosis (MS).

BACKGROUND: It would be useful to identify brain magnetic resonance imaging (MRI) features that help to differentiate between NMOSD and MS. A previous study at 7T has suggested that central vein is not commonly seen in NMOSD lesions, but it is typical of MS.

METHODS: 18 NMOSD (14F, mean [SD] age 52 [±11] yrs, all except two AQP4 antibody positive) and 16 relapsing remitting MS patients (12F, mean [SD] age 41 [±9] yrs) were scanned at 3T. White matter (WM) lesions were first identified on the T2 image and classified as infratentorial, periventricular or subcortical. Subsequently, the presence of at least one vein , depicted as a dark line coursing through the lesion or a dot tracked on contiguous slices, was assessed on SWI. Logistic regression models were used to assess the association between presence of CVS and type of disease (MS vs. NMOSD), after adjusting for age, gender, and disease duration.

RESULTS: A total of 719 WM lesions were seen in 16 of 16 MS patients; 177 lesions were detected in 16 of 18 NMOSD patients. The CVS was identified in 575 (80[percnt]) MS lesions, and 67 (38[percnt]) NMOSD lesions. In both groups, CVS was most commonly seen in periventricular lesions (MS:65[percnt]; NMOSD:63[percnt]), followed by subcortical (MS:25[percnt]; NMOSD:14[percnt]) and infratentorial lesions (MS:10[percnt]; NMOSD:13[percnt]). The presence of the CVS was strongly associated with this WM lesion belonging to a MS patient (OR=6.49, 95[percnt] CI 3.69, 11.69, p<0.001).

CONCLUSIONS: The CVS on SWI is typical of MS patients and can improve the differential diagnosis between MS from NMOSD when using a clinical MRI scanner.