Mention veins and I geta shiver down my spine with the thought of CCSVI and blocked veins However, I heard about central veins from my ex-roomy ProfK. Ex…..cos I have been kicked out due to COVID-19, will I ever get back in? He told me about FLAIR* pronounced flare-snowflake, I mean flare-star. This is a combined magnetic resosoance contrast technique for visualizing White Matter Lesions and parenchymal veins inside the brain tissue. I won’t try and explain what FLAIR is, but the central vein sign makes it easier to spot MS lesions.
Kaisey M, Solomon AJ, Guerrero BL, Renner B, Fan Z, Ayala N, Luu M, Diniz MA, Sati P, Sicotte NL. Preventing multiple sclerosis misdiagnosis using the “central vein sign”: A real-world study. Mult Scler Relat Disord. 2020 Dec 15;48:102671
Background: Misdiagnosis of multiple sclerosis (MS) is common and often occurs due to misattribution of non-MS magnetic resonance imaging (MRI) lesions to MS demyelination. A recently developed MRI biomarker, the central vein sign (CVS), has demonstrated high specificity for MS lesions and may thus help prevent misdiagnosis.
Objective: This study explores the potential “real world” diagnostic value of CVS by comparing CVS in patients with MS and patients previously misdiagnosed with MS.
Methods: Fifteen patients with MS and 15 misdiagnosed with MS were prospectively recruited to undergo 3T brain MRI. T2-weighted fluid-attenuated inversion recovery (FLAIR) and T2*-weighted segmented echo-planar-imaging (T2*-EPI) were acquired. The generated FLAIR* images were analyzed by two independent raters. The percentage of lesions with CVS was calculated for each patient.
Results: A CVS lesion threshold of 29% or higher resulted in high sensitivity (0.79) and specificity (0.88) for MS and correctly identified 87% of patients previously misdiagnosed with MS. Interrater reliability for CVS was high with a Cohen’s kappa coefficient of 0.86.
Conclusion: This study demonstrates the ability of CVS to differentiate between patients with MS and patients with an MS misdiagnosis resulting from standard MRI and clinical evaluation. Clinical application of CVS may reduce MS misdiagnosis.