European Radiology

, Volume 23, Issue 7, pp 1956–1962

The “central vein sign”: is there a place for susceptibility weighted imaging in possible multiple sclerosis?

  • Thomas Kau
  • Manuel Taschwer
  • Hannes Deutschmann
  • Martina Schönfelder
  • Jörg R. Weber
  • Klaus A. Hausegger
Neuro

Abstract

Objectives

Susceptibility weighted imaging (SWI) may have the potential to depict the perivenous extent of white matter lesions (WMLs) in multiple sclerosis (MS). We aimed to assess the discriminatory value of the “central vein sign” (CVS).

Methods

In a 3-T magnetic resonance imaging (MRI) study, 28 WMLs in 14 patients with at least one circumscribed lesion >5 mm and not more than eight non-confluent lesions >3 mm were prospectively included. Only WMLs in FLAIR images with a maximum diameter of >5 mm were correlated to their SWI equivalent for CVS evaluation.

Results

Five patients fulfilled the revised McDonald criteria for MS and nine patients were given alternative diagnoses. Nineteen MS-WMLs and nine non-MS-WMLs >5 mm were detected. Consensus reading found a central vein in 16 out of 19 MS-WMLs (84 %) and in one out of nine non-MS-WMLs (11 %), respectively. The CVS proved to be a highly significant discriminator (P < 0.001) between MS-WMLs and non-MS-WMLs with a sensitivity, specificity, positive and negative predictive value and accuracy of 84 %, 89 %, 94 %, 73 % and 86 %, respectively. Inter-rater agreement was good (κ = 0.77).

Conclusions

Even though the CVS is not exclusively found in MS-WMLs, SWI may be a useful adjunct in patients with possible MS.

Key Points

• MRI continues to yield further information concerning MS lesions.

• SWI adds diagnostic information in patients with possible MS.

• The “central vein sign” was predominantly seen in MS lesions.

• The “central vein sign” helps discriminate between MS and non-MS lesions.

Keywords

Multiple sclerosis White matter lesions Central vein sign Magnetic resonance imaging Susceptibility weighted imaging 

Abbreviations

AP

Antero-posterior

CDMS

Clinically definite multiple sclerosis

CIS

Clinically isolated syndrome

CV

central vein

CVS

Central vein sign

DD

Differential diagnosis

DIS

Dissemination in space

DIT

Dissemination in time

FH

Feet-head

FLAIR

Fluid-attenuated inversion-recovery

mIP

Minimum intensity projection

MS

Multiple sclerosis

PACS

Picture archiving and communication system

RIS

Radiologically isolated syndrome

RL

Right-left

SOCR

Statistics Online Computational Resource

SWI

Susceptibility weighted imaging

WML

white matter lesion

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Copyright information

© European Society of Radiology 2013

Authors and Affiliations

  • Thomas Kau
    • 1
  • Manuel Taschwer
    • 1
  • Hannes Deutschmann
    • 2
  • Martina Schönfelder
    • 3
  • Jörg R. Weber
    • 3
  • Klaus A. Hausegger
    • 1
  1. 1.Klinikum KlagenfurtInstitute of Diagnostic and Interventional RadiologyKlagenfurtAustria
  2. 2.Department of RadiologyMedical University GrazGrazAustria
  3. 3.Department of NeurologyKlinikum KlagenfurtKlagenfurtAustria

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