PHILADELPHIA – according to research presented at the annual meeting of the American Academy of Neurology. Using this criterion in clinical practice is feasible, the researchers added.
Several years ago, researchers proposed the central vein sign as a specific and sensitive imaging biomarker for distinguishing between multiple sclerosis (MS) and its imaging mimics. Recent studies have proposed criteria for this distinction that are based on the proportion of lesions with the central vein sign. Criteria that are based on the absolute numbers of lesions with the central vein sign, however, may be more applicable in clinical practice, said
Dr. Sinnecker and colleagues conducted a multicenter study to evaluate the sensitivity and specificity of criteria that are based on the absolute numbers of lesions with the central vein sign (CVS) in distinguishing MS from non-MS conditions on clinical 3T brain MRI. They analyzed 606 participants with clinically isolated syndrome (CIS; n = 117), relapsing remitting MS (RRMS; n = 236, of whom 108 had a disease duration shorter than 5 years), aquaporin 4 antibody–positive neuromyelitis optica spectrum disorder (n = 32), systemic lupus erythematosus (n = 25), migraine (n = 29), cluster headache (n = 5), diabetes mellitus (n = 20), or other types of small-vessel disease (n = 142). Raters blinded to clinical data and lesion distribution determined the occurrence of CVS on 3T T2*-weighted or susceptibility-weighted imaging. The researchers assessed the sensitivity and specificity of different CVS lesion criteria that were defined according to the absolute numbers of lesions with CVS.
In total, Dr. Sinnecker and colleagues analyzed 4,447 lesions. The “two-CVS-lesions criterion” (two or more lesions with CVS) had a sensitivity and specificity of 76.2% and 79.3%, respectively, in distinguishing between RRMS/CIS and non-MS. The “three-CVS-lesions criterion” (three or more lesions with CVS) had a sensitivity and specificity of 61.9% and 89.0%, respectively. The observed sensitivity and specificity values were consistent across all disease subgroups examined in the study, including CIS and early RRMS. These results indicate that positive criteria based on CVS could be used to support the diagnosis of MS, Dr. Sinnecker said.
Dr. Sinnecker reported receiving personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Actelion.
SOURCE: Sinnecker T et al. AAN 2019, Abstract S6.002.