Value of the central vein sign at 3T to differentiate MS from seropositive NMOSD

Rosa Cortese, Lise Magnollay, Carmen Tur, Khaled Abdel-Aziz, Anu Jacob, Floriana De Angelis, Marios C Yiannakas, Ferran Prados, Sebastien Ourselin, Tarek A Yousry, Frederik Barkhof, Olga Ciccarelli

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

OBJECTIVE: To assess the value of the central vein sign (CVS) on a clinical 3T scanner to distinguish between multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD).

METHODS: Eighteen aquaporin-4-antibody-positive patients with NMOSD, 18 patients with relapsing-remitting MS, and 25 healthy controls underwent 3T MRI. The presence of a central vein in white matter lesions on susceptibility-weighted imaging, defined as a thin hypointense line or a small dot, was recorded.

RESULTS: The proportion of lesions with the CVS was higher in MS than NMOSD (80% vs 32%, p < 0.001). A greater proportion of lesions with the CVS predicted the diagnosis of MS, rather than NMOSD (odds ratio 1.10, 95% confidence interval [CI] 1.04 to 1.16, p = 0.001), suggesting that each percent unit increase in the proportion of lesions with the CVS in an individual patient was associated with a 10% increase in the risk of the same patient having MS. If more than 54% of the lesions on any given scan show the CVS, then the patient can be given a diagnosis of MS with an accuracy of 94% (95% CIs 81.34, 99.32, p < 0.001, sensitivity/specificity 90%/100%).

CONCLUSION: The clinical value of the CVS in the context of the differential diagnosis between MS and NMOSD, previously suggested using 7T scanners, is now extended to clinical 3T scanners, thereby making a step towards the use of CVS in clinical practice.

CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that the CVS on 3T MRI accurately distinguishes patients with MS from those with seropositive NMOSD.

Original languageEnglish
Pages (from-to)e1183-e1190
JournalNeurology
Volume90
Issue number14
DOIs
Publication statusPublished - 3 Apr 2018

Cite this

Cortese, R., Magnollay, L., Tur, C., Abdel-Aziz, K., Jacob, A., De Angelis, F., ... Ciccarelli, O. (2018). Value of the central vein sign at 3T to differentiate MS from seropositive NMOSD. Neurology, 90(14), e1183-e1190. https://doi.org/10.1212/WNL.0000000000005256
Cortese, Rosa ; Magnollay, Lise ; Tur, Carmen ; Abdel-Aziz, Khaled ; Jacob, Anu ; De Angelis, Floriana ; Yiannakas, Marios C ; Prados, Ferran ; Ourselin, Sebastien ; Yousry, Tarek A ; Barkhof, Frederik ; Ciccarelli, Olga. / Value of the central vein sign at 3T to differentiate MS from seropositive NMOSD. In: Neurology. 2018 ; Vol. 90, No. 14. pp. e1183-e1190.
@article{8c66a6cff7314978973db290ade7f4e4,
title = "Value of the central vein sign at 3T to differentiate MS from seropositive NMOSD",
abstract = "OBJECTIVE: To assess the value of the central vein sign (CVS) on a clinical 3T scanner to distinguish between multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD).METHODS: Eighteen aquaporin-4-antibody-positive patients with NMOSD, 18 patients with relapsing-remitting MS, and 25 healthy controls underwent 3T MRI. The presence of a central vein in white matter lesions on susceptibility-weighted imaging, defined as a thin hypointense line or a small dot, was recorded.RESULTS: The proportion of lesions with the CVS was higher in MS than NMOSD (80{\%} vs 32{\%}, p < 0.001). A greater proportion of lesions with the CVS predicted the diagnosis of MS, rather than NMOSD (odds ratio 1.10, 95{\%} confidence interval [CI] 1.04 to 1.16, p = 0.001), suggesting that each percent unit increase in the proportion of lesions with the CVS in an individual patient was associated with a 10{\%} increase in the risk of the same patient having MS. If more than 54{\%} of the lesions on any given scan show the CVS, then the patient can be given a diagnosis of MS with an accuracy of 94{\%} (95{\%} CIs 81.34, 99.32, p < 0.001, sensitivity/specificity 90{\%}/100{\%}).CONCLUSION: The clinical value of the CVS in the context of the differential diagnosis between MS and NMOSD, previously suggested using 7T scanners, is now extended to clinical 3T scanners, thereby making a step towards the use of CVS in clinical practice.CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that the CVS on 3T MRI accurately distinguishes patients with MS from those with seropositive NMOSD.",
author = "Rosa Cortese and Lise Magnollay and Carmen Tur and Khaled Abdel-Aziz and Anu Jacob and {De Angelis}, Floriana and Yiannakas, {Marios C} and Ferran Prados and Sebastien Ourselin and Yousry, {Tarek A} and Frederik Barkhof and Olga Ciccarelli",
note = "{\circledC} 2018 American Academy of Neurology.",
year = "2018",
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Cortese, R, Magnollay, L, Tur, C, Abdel-Aziz, K, Jacob, A, De Angelis, F, Yiannakas, MC, Prados, F, Ourselin, S, Yousry, TA, Barkhof, F & Ciccarelli, O 2018, 'Value of the central vein sign at 3T to differentiate MS from seropositive NMOSD' Neurology, vol. 90, no. 14, pp. e1183-e1190. https://doi.org/10.1212/WNL.0000000000005256

Value of the central vein sign at 3T to differentiate MS from seropositive NMOSD. / Cortese, Rosa; Magnollay, Lise; Tur, Carmen; Abdel-Aziz, Khaled; Jacob, Anu; De Angelis, Floriana; Yiannakas, Marios C; Prados, Ferran; Ourselin, Sebastien; Yousry, Tarek A; Barkhof, Frederik; Ciccarelli, Olga.

In: Neurology, Vol. 90, No. 14, 03.04.2018, p. e1183-e1190.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Value of the central vein sign at 3T to differentiate MS from seropositive NMOSD

AU - Cortese, Rosa

AU - Magnollay, Lise

AU - Tur, Carmen

AU - Abdel-Aziz, Khaled

AU - Jacob, Anu

AU - De Angelis, Floriana

AU - Yiannakas, Marios C

AU - Prados, Ferran

AU - Ourselin, Sebastien

AU - Yousry, Tarek A

AU - Barkhof, Frederik

AU - Ciccarelli, Olga

N1 - © 2018 American Academy of Neurology.

PY - 2018/4/3

Y1 - 2018/4/3

N2 - OBJECTIVE: To assess the value of the central vein sign (CVS) on a clinical 3T scanner to distinguish between multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD).METHODS: Eighteen aquaporin-4-antibody-positive patients with NMOSD, 18 patients with relapsing-remitting MS, and 25 healthy controls underwent 3T MRI. The presence of a central vein in white matter lesions on susceptibility-weighted imaging, defined as a thin hypointense line or a small dot, was recorded.RESULTS: The proportion of lesions with the CVS was higher in MS than NMOSD (80% vs 32%, p < 0.001). A greater proportion of lesions with the CVS predicted the diagnosis of MS, rather than NMOSD (odds ratio 1.10, 95% confidence interval [CI] 1.04 to 1.16, p = 0.001), suggesting that each percent unit increase in the proportion of lesions with the CVS in an individual patient was associated with a 10% increase in the risk of the same patient having MS. If more than 54% of the lesions on any given scan show the CVS, then the patient can be given a diagnosis of MS with an accuracy of 94% (95% CIs 81.34, 99.32, p < 0.001, sensitivity/specificity 90%/100%).CONCLUSION: The clinical value of the CVS in the context of the differential diagnosis between MS and NMOSD, previously suggested using 7T scanners, is now extended to clinical 3T scanners, thereby making a step towards the use of CVS in clinical practice.CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that the CVS on 3T MRI accurately distinguishes patients with MS from those with seropositive NMOSD.

AB - OBJECTIVE: To assess the value of the central vein sign (CVS) on a clinical 3T scanner to distinguish between multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD).METHODS: Eighteen aquaporin-4-antibody-positive patients with NMOSD, 18 patients with relapsing-remitting MS, and 25 healthy controls underwent 3T MRI. The presence of a central vein in white matter lesions on susceptibility-weighted imaging, defined as a thin hypointense line or a small dot, was recorded.RESULTS: The proportion of lesions with the CVS was higher in MS than NMOSD (80% vs 32%, p < 0.001). A greater proportion of lesions with the CVS predicted the diagnosis of MS, rather than NMOSD (odds ratio 1.10, 95% confidence interval [CI] 1.04 to 1.16, p = 0.001), suggesting that each percent unit increase in the proportion of lesions with the CVS in an individual patient was associated with a 10% increase in the risk of the same patient having MS. If more than 54% of the lesions on any given scan show the CVS, then the patient can be given a diagnosis of MS with an accuracy of 94% (95% CIs 81.34, 99.32, p < 0.001, sensitivity/specificity 90%/100%).CONCLUSION: The clinical value of the CVS in the context of the differential diagnosis between MS and NMOSD, previously suggested using 7T scanners, is now extended to clinical 3T scanners, thereby making a step towards the use of CVS in clinical practice.CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that the CVS on 3T MRI accurately distinguishes patients with MS from those with seropositive NMOSD.

U2 - 10.1212/WNL.0000000000005256

DO - 10.1212/WNL.0000000000005256

M3 - Article

VL - 90

SP - e1183-e1190

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 14

ER -

Cortese R, Magnollay L, Tur C, Abdel-Aziz K, Jacob A, De Angelis F et al. Value of the central vein sign at 3T to differentiate MS from seropositive NMOSD. Neurology. 2018 Apr 3;90(14):e1183-e1190. https://doi.org/10.1212/WNL.0000000000005256