Investigation of the “central vein sign” in infratentorial multiple sclerosis lesions

Weber, Christian; Sandikci, Vesile; Ebert, Anne; Szabo, Kristina; Platten, Michael; Gass, Achim; Eisele, Philipp

doi:10.1016/j.msard.2020.102409

Cited by 10 publications

(14 citation statements)

References 32 publications

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“…However, a recent study by Weber et al 67 demonstrated the presence of a CVS in the majority of infratentorial lesions. Interestingly, no differences were observed between CVS frequencies of infratentorial lesions compared to paraventricular lesions or subcortical lesions, while infratentorial lesions showed a CVS more often than juxtacortical lesions.…”

Section: Discussionmentioning

confidence: 96%

“…Interestingly, no differences were observed between CVS frequencies of infratentorial lesions compared to paraventricular lesions or subcortical lesions, while infratentorial lesions showed a CVS more often than juxtacortical lesions. 67 An additional limitation to the definition of a CVS is confluent lesions that constitute a significant portion of the total number of white matter lesions. Indeed, depending on the level of lesion burden, confluent lesions can range from two to twelve overlapping lesions making it impossible to distinct individual lesions, thereby hindering a proper assessment of CVS in MS. 68 A new technique, however, has been introduced to address this issue that included a fully automated method using cutting-edge statistical models for segmenting lesion tissue and well-demonstrated mathematic methods for quantifying texture to obtain the number and location of temporally distinct white matter lesions.…”

Section: Discussionmentioning

confidence: 99%

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Central vein sign: A putative diagnostic marker for multiple sclerosis

Chaaban

Safwan

Moussa

et al. 2021

Acta Neuro Scandinavica

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The relation between the cerebrovascular system and multiple sclerosis (MS) lesions had first been documented in 1863 by Rindfleisch et al. 1 and later revisited by Dow et al. in the mid-1900. 2 It was hypothesized that MS lesion formation depends on the entry of inflammatory cells from the systemic circulation into the brain parenchyma possibly from a disrupted endothelium of venules. 3-5 More recently, the presence of a "central vein sign" (CVS) on MRI has been introduced as a biomarker for the diagnosis of MS. 6 Indeed, several studies have shown that CVS has the ability to accurately differentiate MS from other white matter diseases such as neuromyelitis optica spectrum disorder, 7 systemic autoimmune diseases (Behçet syndrome, systemic lupus erythematosus, and antiphospholipid syndrome), 8

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Central vein sign: A putative diagnostic marker for multiple sclerosis

Chaaban

Safwan

Moussa

et al. 2021

Acta Neuro Scandinavica

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“…An acquisition with thinner slices or isotropic resolution of 1 mm or higher may be preferable for depicting small central vein signals, 9,10 and data may be acquired using faster methods, including segmented echo‐planar imaging 29 . The MS MRI community is yet to standardize image resolution, and currently, various voxel sizes are used resulting in various rates of CVS detection in MS lesions 12,13,15 …”

Section: Discussionmentioning

confidence: 99%

The central vein sign in multiple sclerosis lesions: Susceptibility relaxation optimization from a routine MRI multiecho gradient echo sequence

Huang

Luo

et al. 2021

Journal of Neuroimaging

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Background and Purpose:The white matter lesion central vein sign (CVS) is an emerging biomarker for multiple sclerosis (MS) differential diagnosis. Currently, CVS is detected on susceptibility weighted imaging (SWI) with suboptimal contrast. We developed an imaging method called susceptibility relaxation optimization (SRO) to improve CVS visualization. Methods:This was a retrospective study of MS patients who had MRI in June 2018 with routine 3D multiecho gradient echo (GRE) and T2-weighted fluid-attenuated inversion recovery (FLAIR) sequences. SRO and SWI images were reconstructed from GRE data. MS lesions were identified on FLAIR image. The CVS detection rate, the image quality score of CVS conspicuity (range 0-3), and central vein-to-lesion contrast were compared between SRO and SWI images. Results:In 20 MS patients (mean age 45 ± 9 years; 15 women), SRO significantly increased CVS detection rate compared to SWI (53.3%, 274/514 vs. 32.9%, 169/514; p<.001, McNemar's test). The median image quality score for SRO was 2 compared to 1 for SWI (p<.001, Wilcoxon signed-rank test). The median overall image quality score for SRO was 7 compared to 6 for SWI (p = .003; Wilcoxon signed-rank test). Central vein-tolesion contrast was 0.12 ± 0.12 in SRO compared to 0.031 ± 0.075 in SWI (p<.001, t-test).Conclusions: SRO yields better central vein contrast and increases CVS detection rate compared to SWI.

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“…[5][6][7][11][12][13][14] Due to its sensitivity to ferritin, hemosiderin, and deoxyhemoglobin, 15,16 SWI can furthermore visualize the cerebral venous architecture, and previous MRI studies demonstrated that penetrating veins can be detected in the majority of MS lesions. [17][18][19] However, only a few cross-sectional studies investigated the venous diameter in a quantitative manner, 20,21 and particularly longitudinal data concerning the temporal dynamics have been scarce until now. 22 The aim of this study was to investigate temporal evolution of the venous diameter in chronic active and nonenhancing shrinking MS lesions in a longitudinal MRI study.…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies demonstrated that in chronic active MS lesions active myelin breakdown, iron‐laden macrophages, and reactive astrocytes at the lesion edge can be visualized as hypointense paramagnetic rims on susceptibility‐weighted imaging (SWI) 5–7,11–14 . Due to its sensitivity to ferritin, hemosiderin, and deoxyhemoglobin, 15,16 SWI can furthermore visualize the cerebral venous architecture, and previous MRI studies demonstrated that penetrating veins can be detected in the majority of MS lesions 17–19 . However, only a few cross‐sectional studies investigated the venous diameter in a quantitative manner, 20,21 and particularly longitudinal data concerning the temporal dynamics have been scarce until now 22 .…”

Section: Introductionmentioning

confidence: 99%

Venous Diameter Changes in Chronic Active Multiple Sclerosis Lesions

Weber

Kraemer

Dabringhaus

et al. 2020

Journal of Neuroimaging

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BACKGROUND AND PURPOSE: To investigate the temporal evolution of venous diameter in chronic active and nonenhancing shrinking multiple sclerosis (MS) lesions in a longitudinal magnetic resonance imaging (MRI) study including susceptibilityweighted images (SWI). METHODS: We compared the venous diameter in chronic active and nonenhancing shrinking lesions to the venous diameter in nonenhancing stable lesions on two 3 T MRI data sets obtained 12 months apart. Chronic active and nonenhancing shrinking lesions were identified by Voxel-Guided Morphometry. Coregistered, overlaid fluid-attenuated inversion recovery/SWI were analyzed for the presence of a central vein. Quantitative calculation of the venous diameter for each time point was performed on the reconstructed veins. RESULTS: Sixty-two relapsing-remitting MS patients (50 women; mean age: 36 ± 11 years; mean disease duration: 4 ± 7 years) were included in the study. Overall, we identified 222 chronic MS lesions (48 chronic active, 48 shrinking, 126 stable) with a corresponding intralesional central vein. On baseline MRI, the mean venous diameter did not statistically differ between all subgroups, whereas on follow-up MRI, the mean intralesional venous diameter was smaller in chronic active (0.92 ± 0.15 mm) and shrinking lesions (0.90 ± 0.19 mm) compared to stable lesions (1.10 ± 0.18 mm; P < .001). CONCLUSION: Our findings demonstrate venous narrowing in chronic active and nonenhancing shrinking MS lesions. The smaller diameter of intralesional veins during follow up in these lesions may reflect structural, degenerative, and metabolic changes due to chronic inflammation, (perivascular) fibrosis, collagenous thickening, and increased levels of oxygenated hemoglobin.

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Investigation of the “central vein sign” in infratentorial multiple sclerosis lesions

Cited by 10 publications

References 32 publications

Central vein sign: A putative diagnostic marker for multiple sclerosis

Central vein sign: A putative diagnostic marker for multiple sclerosis

The central vein sign in multiple sclerosis lesions: Susceptibility relaxation optimization from a routine MRI multiecho gradient echo sequence

Venous Diameter Changes in Chronic Active Multiple Sclerosis Lesions

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