TY - JOUR
T1 - The “central vein sign” in patients with diagnostic “red flags” for multiple sclerosis
T2 - A prospective multicenter 3T study
AU - Maggi, Pietro
AU - Absinta, Martina
AU - Sati, Pascal
AU - Perrotta, Gaetano
AU - Massacesi, Luca
AU - Dachy, Bernard
AU - Pot, Caroline
AU - Meuli, Reto
AU - Reich, Daniel S.
AU - Filippi, Massimo
AU - Pasquier, Renaud Du
AU - Théaudin, Marie
N1 - Funding Information:
The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: M.F. is Editor-in-Chief of the Journal of Neurology; received compensation for consulting services and/or speaking activities from Biogen Idec, Merck-Serono, Novartis, and Teva Pharmaceutical Industries; and receives research support from Biogen Idec, Merck-Serono, Novartis, Teva Pharmaceutical Industries, Roche, Italian Ministry of Health, Fondazione Italiana Sclerosi Multipla, and ARiSLA (Fondazione Italiana di Ricerca per la SLA). M.T. has no conflict of interest involving the work under consideration for publication and no relationships or activities that readers could perceive to have influenced or that give the appearance of potentially influencing what is written in the submitted work. Outside the submitted work, she received speaker honoraria from Merck, Biogen Idec, Genzyme, and Roche; fees for advisory boards from Merck, Biogen Idec, and Novartis; and travel grants from Merck, Biogen Idec, Genzyme, Roche, and Novartis. All the other authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Funding Information:
The authors thank Dr Camillo Ribi (Division of Immunology and Allergology, Lausanne University Hospital), Dr Vasiliki Pantazou (Neuroimmunology Unit, Lausanne University Hospital), Dr Prochore S. Kamgang, Dr Monica Ferreira (Division of Internal Medicine, H?pital Brugmann, Brussels, Belgium), Dr Raphael Hourez (Neurology Department, H?pital Brugmann, Brussels, Belgium), and Pr Vincent van Pesch (Neurology Department, Cliniques Universitaires Saint Luc, Brussels, Belgium) for their time and help in patient recruitment and management; G?raldine le Goff (MS research nurse, Neuroimmunology Unit, Lausanne University Hospital) for helping with patients? clinical and biological data collection; Tobias Kober, Mario Fartaria de Oliveira, and Jonas Richiardi (MRI research lab, Siemens Healthineers, Lausanne) and Julie Absil and Thierry Methens (H?pital Erasme, Brussels, Belgium) for helping with MRI sequence implementation and image post-processing; Jean-Baptiste Ledoux (TRM coordinator, service de ?radiodiagnostic et radiologie interventionnelle,? Lausanne University Hospital) for helping with MRI acquisition; Dr Vittorio Martinelli (Neurology department, San Raffaele Hospital, Milan, Italy) for patient recruitment and management; and Dr Roberta Scotti and Antonella Iadanza (Neuroradiology department, San Raffaele Hospital, Milan, Italy) for helping with MRI image acquisition. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: P.M. is supported by the ECTRIMS Clinical Training Fellowship Program and by the University of Lausanne ?rel?ve acad?mique? grant. M.A. is supported by the National Multiple Sclerosis Society (NMSS) (grant #FG 2093-A-1) and the Conrad N. Hilton Foundation (grant #17313). M.A., P.S., and D.S.R. are supported by the Intramural Research Program of the National Institute of Neurological Disorders and Stroke. B.D. reports no funding or support directly relevant to the manuscript.
Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: P.M. is supported by the ECTRIMS Clinical Training Fellowship Program and by the University of Lausanne “relève académique” grant. M.A. is supported by the National Multiple Sclerosis Society (NMSS) (grant #FG 2093-A-1) and the Conrad N. Hilton Foundation (grant #17313). M.A., P.S., and D.S.R. are supported by the Intramural Research Program of the National Institute of Neurological Disorders and Stroke. B.D. reports no funding or support directly relevant to the manuscript.
Publisher Copyright:
© The Author(s), 2019.
PY - 2020/4/1
Y1 - 2020/4/1
N2 - Background: The central vein sign (CVS) has been shown to help in the differential diagnosis of multiple sclerosis (MS), but most prior studies are retrospective. Objectives: To prospectively assess the diagnostic predictive value of the CVS in diagnostically difficult cases. Methods: In this prospective multicenter study, 51 patients with suspected MS who had clinical, imaging, or laboratory “red flags” (i.e. features atypical for MS) underwent 3T fluid-attenuated inversion recovery (FLAIR*) magnetic resonance imaging (MRI) for CVS assessment. After the diagnostic work-up, expert clinicians blinded to the results of the CVS assessment came to a clinical diagnosis. The value of the CVS to prospectively predict an MS diagnosis was assessed. Results: Of the 39 patients who received a clinical diagnosis by the end of the study, 27 had MS and 12 received a non-MS diagnosis that included systemic lupus erythematosus, sarcoidosis, migraine, Sjögren disease, SPG4-spastic-paraparesis, neuromyelitis optica, and Susac syndrome. The percentage of perivenular lesions was higher in MS (median = 86%) compared to non-MS (median = 21%; p < 0.0001) patients. A 40% perivenular lesion cutoff was associated with 97% accuracy and a 96% positive/100% negative predictive value. Conclusion: The CVS detected on 3T FLAIR* images can accurately predict an MS diagnosis in patients suspected to have MS, but with atypical clinical, laboratory, and imaging features.
AB - Background: The central vein sign (CVS) has been shown to help in the differential diagnosis of multiple sclerosis (MS), but most prior studies are retrospective. Objectives: To prospectively assess the diagnostic predictive value of the CVS in diagnostically difficult cases. Methods: In this prospective multicenter study, 51 patients with suspected MS who had clinical, imaging, or laboratory “red flags” (i.e. features atypical for MS) underwent 3T fluid-attenuated inversion recovery (FLAIR*) magnetic resonance imaging (MRI) for CVS assessment. After the diagnostic work-up, expert clinicians blinded to the results of the CVS assessment came to a clinical diagnosis. The value of the CVS to prospectively predict an MS diagnosis was assessed. Results: Of the 39 patients who received a clinical diagnosis by the end of the study, 27 had MS and 12 received a non-MS diagnosis that included systemic lupus erythematosus, sarcoidosis, migraine, Sjögren disease, SPG4-spastic-paraparesis, neuromyelitis optica, and Susac syndrome. The percentage of perivenular lesions was higher in MS (median = 86%) compared to non-MS (median = 21%; p < 0.0001) patients. A 40% perivenular lesion cutoff was associated with 97% accuracy and a 96% positive/100% negative predictive value. Conclusion: The CVS detected on 3T FLAIR* images can accurately predict an MS diagnosis in patients suspected to have MS, but with atypical clinical, laboratory, and imaging features.
KW - Central vein sign
KW - MS diagnosis
KW - red flags
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U2 - 10.1177/1352458519876031
DO - 10.1177/1352458519876031
M3 - Article
C2 - 31536435
AN - SCOPUS:85073936532
SN - 1352-4585
VL - 26
SP - 421
EP - 432
JO - Multiple Sclerosis Journal
JF - Multiple Sclerosis Journal
IS - 4
ER -