Central vein sign detected by SWI at 3 T MRI as a discriminator between multiple sclerosis and leukoaraiosis

Abstract

Background: MRI is an essential tool for diagnosing multiple sclerosis; however, overlap with nonspecific white matter lesions still exists. The central vein sign as detected by MR susceptibility weighted imaging has been proposed to improve the diagnostic accuracy of MRI in MS. Purpose: To assess the value of the central vein sign at susceptibility weighted imaging in discriminating between MS-WMLs and leukoaraiosis-WMLs. Patients and methods: Thirty MS patients and 30 patients with leukoaraiosis, matched for age and gender were included in this study. On axial FLAIR, white matter lesions ≥ 5 mm were counted and subsequently assessed on the axial SWI sequence for the presence of the central vein. The cut-off value of CVS positivity of lesions was evaluated using ROC curve. Results: CVS was detected in 86.84% of MS lesions and in 13.33% of leukoaraiosis lesions with statistically significant difference.The sensitivity, specificity, positive and negative predictive values of individual CVS positive lesion in diagnosing MS were 86.84%, 86.6%, 88.7% and 75.72% respectively. A specificity of 100% was attained when CVS positive lesion load is ≥47.5%. Conclusion: Central vein sign is a fairly reliable discriminator between MS and leukoaraiosis. Keywords: Central vein sign, Multiple sclerosis, Leukoaraiosis, Susceptibility weighted imaging.