Emerging research suggests that a six-minute magnetic resonance imaging (MRI) exam for assessment of the central vein sign (CVS) provides similar sensitivity for multiple sclerosis (MS) as traditional evaluation for cerebrospinal fluid (CSF) oligoclonal bands (OCBs).
For the multicenter prospective study, recently published in Neurology, researchers compared T2-weighted brain MRI detection at a 40 percent threshold for the central vein sign (CVS) to assessment of CSF OCBs (which require a lumbar puncture) for detection of MS. The cohort was comprised of 99 participants (mean age of 38) who presented with a clinically isolated syndrome (CIS), according to the study.
The researchers found that employing the 40 percent CVS threshold for the six-minute MRI provided a 90 percent sensitivity for MS detection in comparison to 83.3 percent for CSF OCB testing. Using the “rule of 6” definition of CVS (seeing six or more lesions with a central venule) had a 91.3 percent sensitivity for MS detection, according to the study authors.
While CSF OCB offered 100 percent specificity for MS detection, the researchers noted that both the 40 percent threshold for CVS and the rule of 6 CVS definition had 57.1 percent specificity. However, the study authors also noted comparable positive predictive value (100 percent for CSF OCB, 96 percent for the 40 percent CVS threshold and 96.1 percent for the CVS rule of 6) and negative predictive value (35 percent for CSF OCB, 36.4 percent for the CVS rule of 6 and 33.3 percent for the CVS 40 percent threshold).
“Diagnostic (lumbar puncture), known to be associated with iatrogenic morbidity, has been used by many centers aiming to expedite the diagnosis of MS as per the 2017 (McDonald) modified diagnostic criteria. Our results demonstrate that the CVS, including the rule of 6, has equivalent sensitivity to OCB testing using a prospective, multicenter study of participants presenting with typical CIS,” wrote lead study author Christopher Martin Allen, M.D., who is affiliated with the Mental Health and Clinical Neurosciences Academic Unit with the School of Medicine at the University of Nottingham in Nottingham, England, and colleagues.
The researchers also found that 74 study participants (75 percent) reported side effects related to the lumbar puncture. In contrast, nine participants (9 percent) reported side effects after having the MRI.
“Headache was reported by 33% and back pain by 27%, which were the commonest problems following the LP, which necessitated up to a fortnight off work or usual caring responsibilities in 15% of study participants. The MRI scans occasionally caused brief dizziness or claustrophobia, but there were no reports of time off work,” added Allen and colleagues.
Three Key Takeaways
1. Central vein sign (CVS) on MRI shows comparable sensitivity to CSF OCBs. A six-minute brain MRI detecting the central vein sign (CVS) using the “rule of 6” or a 40 percent lesion threshold provides similar sensitivity (~90%) for diagnosing multiple sclerosis (MS) compared to testing for cerebrospinal fluid (CSF) oligoclonal bands (OCBs).
2. Non-invasive alternative with fewer side effects. MRI-based CVS detection is significantly less invasive than lumbar puncture and associated with fewer and milder side effects (9 percent vs. 75 percent for LP), potentially reducing patient burden and time off work.
3. Feasible integration into routine imaging protocols. The study supports the practical addition of T2-weighted or susceptibility-weighted sequences to standard 3T MRI protocols, making CVS assessment a viable, rapid adjunct for early MS diagnosis in suspected cases.
For centers with 3T MRI scanners, the study authors suggested that MRI assessment for CVS could easily be incorporated into the diagnostic workup for those with suspected MS.
“ … A T2 sequence (or a similar sequence such as (susceptibility-weighted imaging)) that takes minutes to acquire can easily be added on to standard MRI brain protocols when MS is suspected,” posited Allen and colleagues.
(Editor’s note: For related content, see “Can Deep Learning Enhance Low-Field MRI for Multiple Sclerosis Assessment?,” “AI Software for Brain MRI Gets Expanded FDA Clearance for Multiple Sclerosis Assessment” and “Multicenter Study Shows 26 Percent of Multiple Sclerosis Relapses Not Associated with New Lesions on MRI.”)
In regard to study limitations, the authors acknowledged the lack of a comparative gold standard for MS diagnosis and noted that the three participating facilities had MS specialists.
