Central Vein for MS diagnosis

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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.

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A = FLAIR*, B=FLAIR, C=T2* The flair* lesions are the white blobs

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.

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MouseDoctor

12 comments

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  • Thank you so much for sharing research. People like me who also have MS can spend so much time weeding through research studies and not find anything new after hours of searching.
    I have a question if anyone is willing to answer or even just guess.

    Can CVS cause lesions in the brain and/or spinal cord too? Thanks again.

  • I tried to comment on this before but it didn’t go through. Anyway thanks again for sharing this research.
    Does anyone know if CVS can cause lesions in the brain or spinal cord?

      • So if someone who has already been diagnosed with MS and is later diagnosed with CVS, it doesn’t mean that they were misdiagnosed with MS? Both conditions appear in the same individuals?

        I’m sorry, but the results and conclusion are making it sound to me like a diagnosis of CVS indicates a misdiagnosis of MS? I know that I’m asking too many questions and I hate being that person. I have had problems with my circulation for years.

        They’ve worsened in the last 6 months or so. My feet, especially my right foot, now turn a dark shade of purple when I’m standing up and even just sitting up on a hard chair with my feet in the air or on the floor. The right one swells up more.

        It even turns red and gets a bit swollen when I’m lying down. The dark purple freaks other people out when I’m standing there talking to them and they look down at my feet. I take aspirin at night but that doesn’t help. I feel like I’m in some weird rabbit hole of health issues that no one can explain.

        I know that no one here is my doctor, but I’d really love to have ideas of what might be going on so that I could mention them to her. I wish that I could post the weird pictures of my feet here :/ my feet themselves aren’t yucky gross looking, I do pedicures myself since covid hit 😂 but the circulation and swelling is a bit alarming to look at.

        • CVS is an imaging sign (a blood vessel inside a perivascualr cuff of white blood cells) so everyone with MS has CVS

  • Aww you’ve been turfed out of your mousehole MD? And Prof K gets that huge luxury office all to himself?
    Stay safe working in London 😷😊

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