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

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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.

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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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Acknowledgements

The abstract of this scientific paper (ctrl no. 2123) has been accepted for oral presentation at ECR 2013.

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Authors and Affiliations

  1. Klinikum Klagenfurt, Institute of Diagnostic and Interventional Radiology, Feschnigstrasse 11, 9020, Klagenfurt, Austria

    Thomas Kau, Manuel Taschwer & Klaus A. Hausegger

  2. Department of Radiology, Medical University Graz, Auenbruggerplatz 9, 8010, Graz, Austria

    Hannes Deutschmann

  3. Department of Neurology, Klinikum Klagenfurt, Feschnigstrasse 11, 9020, Klagenfurt, Austria

    Martina Schönfelder & Jörg R. Weber

Authors
  1. Thomas Kau
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  2. Manuel Taschwer
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  3. Hannes Deutschmann
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  6. Klaus A. Hausegger
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Correspondence to Thomas Kau.

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Kau, T., Taschwer, M., Deutschmann, H. et al. The “central vein sign”: is there a place for susceptibility weighted imaging in possible multiple sclerosis?. Eur Radiol 23, 1956–1962 (2013). https://doi.org/10.1007/s00330-013-2791-4

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  • DOI: https://doi.org/10.1007/s00330-013-2791-4

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