Value of central vein sign in discriminating multiple sclerosis plaques from other white matter lesions

Abstract

Introduction: Susceptibility weighted (SW) magnetic resonance imaging (MRI) can visualize the vein/s around which multiple sclerosis (MS) plaques are centered. This study's purpose was to assess the ability of the central vein sign (CVS) to differentiate MS plaques from non MS white matter lesions (WMLs). Methods: Out of 18 patients, 9 had MS, 3 had systemic lupus erythematosus, 4 had hypertensive microangiopathy and 2 had Behcet’s disease. 3 T MRI examination was performed to obtain fluid attenuated inversion recovery (FLAIR) and the SW images. Lesions more than 3 mm were identified and analyzed for location and existence of the CVS. Results: Out of 572 MS lesions, 281 lesions were positive for the CVS, while only 66 out of 279 non MS lesions were CVS positive with a statistically significant difference between the two groups (p < 0.001). As regards the percentage of perivenous lesions per patient; using a cutoff value of 30%, MRI accurately segregated all patients with MS and 8/9 non MS patients. Conclusion: Though the CVS is not found solely in MS lesions it is more frequent in MS WMLs as compared to non MS WML and thus is reliable adjunctive tool in differentiation of MS plaques from WMLs of alternative etiologies. Keywords: Central vein sign, Multiple sclerosis, Susceptibility weighted imaging, White matter lesions