The central vein sign is present in most infratentorial multiple sclerosis plaques

• Published in: Multiple sclerosis and related disorders 2022-02, Vol.58, p.103484-103484, Article 103484
• Main Authors: Gaitán, María Inés, Paday Formenti, María Emilia, Calandri, Ismael, Ysrraelit, María Célica, Yañez, Paulina, Correale, Jorge
• Format: Article
• Language: English
• Subjects: Brain - pathology; Central vein sign; Humans; Magnetic Resonance Imaging - methods; Multiple sclerosis; Multiple Sclerosis - diagnosis; Susceptibility MRI; Veins - pathology
• ISSN: 2211-0348; 2211-0356
• DOI: 10.1016/j.msard.2021.103484

•Optimized SWAN is sensitive to infratentorial multiple sclerosis lesions.•The central vein sign is present in the majority of infratentorial plaques.•As in the supratentorial brain, infratentorial MS lesions are centered by veins. There is growing evidence supporting the presence of the central vein sign (CVS) in the supratentorial brain as an imaging biomarker for multiple sclerosis (MS) diagnosis. Recently, using optimized susceptibility-weighted angiography (SWAN-venule), we detected CVS in 86% of supratentorial white matter lesions (WMLs) in the clinical setting on images obtained in a 3T MRI scanner. Despite the relevance of the infratentorial compartment, CVS prevalence in infratentorial MS plaques has not been investigated in detail. Our objective was to determine the proportion of MS infratentorial lesions showing CVS positivity. We included subjects with MS and other brain diseases showing at least one infratentorial lesion larger than 3 mm on 3D-FLAIR. Patients were scanned in a 3T MRI scanner (GE Medical Systems, discovery-MR750), applying a comprehensive protocol including post-contrast 3D-FLAIR and SWAN-venule sequences. CVS presence was confirmed by two trained raters. Thirty MRIs of subjects with MS were analyzed. One hundred and one infratentorial lesions were detected on FLAIR, and 86% were centered by a vein. Fifteen MRIs from the non-MS group were analyzed, 19 lesions were visible ion FLAIR and 16% were positive for the CVS. SWAN-venule detects infratentorial lesions and highlights the central vein in MS plaques at 3T MRI. As occurs in the supratentorial brain, most infratentorial lesions are perivenular.