The MRI central vein marker; differentiating PPMS from RRMS and ischemic SVD

Abstract

ObjectiveTo determine whether the assessment of brain white matter lesion (WML) central veins differentiate patients with primary progressive MS (PPMS) from relapsing-remitting MS (RRMS) and ischemic small vessel disease (SVD) using 3T MRI.MethodsIn this cross-sectional study, 71 patients with PPMS, RRMS, and SVD were imaged using a T2*-weighted sequence. Two blinded raters identified the total number of WMLs, proportion of WMLs in periventricular, deep white matter (DWM) and juxtacortical regions, and proportion of WMLs with central veins in all patient groups. The proportions were compared between disease groups, including effect sizes. MS or SVD was categorized using a threshold of ≥40% WMLs with central veins as indicative of MS. Interrater and intrarater reproducibility was calculated.ResultsThe mean proportion of WMLs with central veins was 68.4% in PPMS, 74.3% in RRMS, and 4.7% in SVD. The difference in proportions between PPMS and SVD groups was significant (p < 0.0005; effect size: 3.8) but not significant between MS subtypes (p = 0.3; effect size: 0.29). Distribution of WMLs was similar across both MS groups, but despite SVD patients having more DWM lesions than PPMS patients, proportions of WMLs with central veins remained low (2.75% in SVD; 62.5% in PPMS). Interrater and intrarater reproducibility comparing proportions of WMLs with central veins across all patients was 0.86 and 0.90, respectively. Level of agreement between the proportion of WML central veins and established diagnosis was 0.84 and 0.82 for each rater.ConclusionsWML central veins could be used to differentiate PPMS from SVD but not between MS subtypes.

Stronger Microstructural Damage Revealed in Multiple Sclerosis Lesions with Central Vein Sign by Quantitative Gradient Echo MRI

“…We found no significant differences in the presence and proportions of lesions with CVS in relapsing versus progressive MS subtypes, in accord with previous studies. 6,32 These findings are consistent with the CVS reflecting a common lesion pathogenesis among MS subtypes. 32 Of note, PMS subjects trended toward greater proportion of CVS+ lesions versus RRMS subjects.…”

Three-dimensional MRI sequences in MS diagnosis and research

“…Evidence is accumulating rapidly that MS lesions are more often traversed by veins than non-MS white matter hyperintensities, such as those related to migraine or hypertension. 19,64–67 Two small studies have suggested the use of a 40% cut-off value to distinguish MS lesions (40% or more lesions are traversed by a central vein) from non-MS lesions. 66,68 This is in keeping with another in vivo study which found that 80%–94% of periventricular MS lesions contain a central vein, which corresponds to >90% sensitivity and specificity.…”

The role of iron and myelin in orientation dependent R2* of white matter

“…Further correlation with clinical data 55 or biochemical data, such as serum ferritin levels 56 would be straightforward. Note also that 3D gradient echo MRI will likely become part of routine imaging protocols for MS, as it is required for the detection of the central vein sign as a diagnostic marker for MS. [57][58][59][60][61] Lastly, this approach may also be sensitive to diffuse WMwide remyelination rendered possible by future treatment approaches for MS, and may complement measures of remyelination in focal lesions using magnetization transfer imaging, 62 myelin water imaging, 28,63,64 or MR phase based approaches. 65,66 This work has some limitations.…”