Assessing the Clinical Value of the Central Vein Sign in Patients with T2 Hyperintense Lesions on MRI

• Published in: Multiple sclerosis and related disorders 2023-12, Vol.80, p.105203, Article 105203
• Main Authors: Oreja-Guevara, Celia, Vasco, Lorena Garcia, Estevez, Irene Gomez, Camara, Paula Salgado, Alvarez-Linera, Juan, Suarez, Elda Alba
• Format: Article
• Language: English
• ISSN: 2211-0348
• DOI: 10.1016/j.msard.2023.105203

This study investigates the utility of the central vein sign (CVS), a novel marker identified through susceptibility-weighted images (SWI) sequences in high-field (3 T) magnetic resonance imaging (MRI) scans, for differentiating patients with hyperintense lesions in T2-weighted images using brain MRI. A prospective study was conducted involving cranial MRI examinations. These included standard sequences as well as SWI sequences for patients with confirmed MS and those with uncertain diagnoses exhibiting hyperintense lesions in T2-weighted MRI scans. In cases with uncertain diagnoses, clinical data, cerebrospinal fluid (CSF) analysis results, and optic coherence tomography (OCT) variables were collected. A total of 10 patients were analyzed, comprising 5 with uncertain diagnoses and 5 with confirmed MS based on MRI findings meeting the McDonald criteria, along with positive CSF IgG and OCT results. Among the MS patients, 90-100% of their T2 hyperintense lesions exhibited the CVS on SWI sequences. In contrast, all five patients had negative CSF IgG results. Two of these individuals had no lesions displaying CVS; one had recently been diagnosed with migraine and small vessel disease, while the other tested positive for myelin oligodendrocyte glycoprotein (MOG) antibodies. Two other patients with uncertain diagnoses displayed CVS in up to 20% of their lesions and were diagnosed as double negative neuromyelitis optica spectrum disorder (NMOSD). One patient with a headache exhibited CVS in 80% of their lesions, prompting the need for further diagnostic evaluations. In summary, four out of the five patients with uncertain diagnoses had no or very few lesions with CVS, suggesting that MS could be ruled out in these cases. The CVS proves to be a valuable tool for excluding the diagnosis of MS in patients with uncertain diagnoses. This novel marker, observed through SWI sequences, holds promise in enhancing the accuracy of differential diagnoses for individuals presenting with hyperintense lesions in T2-weighted MRI scans.