Abstract
BACKGROUND AND PURPOSE: Radiologically isolated syndrome describes asymptomatic individuals with incidental radiologic abnormalities suggestive of multiple sclerosis. Recent studies have demonstrated that >40% of white matter lesions in MS (and often substantially more) have visible central veins on MR imaging. This “central vein sign” reflects perivenous inflammatory demyelination and can assist in differentiating MS from other white matter disorders. We therefore hypothesized that >40% of white matter lesions in cases of radiologically isolated syndrome would show the central vein sign.
MATERIALS AND METHODS: We recruited 20 participants diagnosed with radiologically isolated syndrome after evaluation by a neurologist. We performed 3T MR imaging of the brain and cervical spinal cord. White matter lesions were analyzed for the central vein sign.
RESULTS: Of 391 total white matter lesions, 292 (75%) demonstrated the central vein sign (central vein sign+). The median proportion of central vein sign+ lesions per case was 87% (range, 29%–100%). When the “40% rule” that has been proposed to distinguish MS from other disorders was applied, of 20 participants, 18 cases of radiologically isolated syndrome (90%) had ≥40% central vein sign+ lesions (range, 55%–100%). Two participants (10%) had <40% central vein sign+ lesions (29% and 31%). When the simpler “rule of 6” was applied, 19 participants (95%) met these criteria. In multivariable models, the number of spinal cord and infratentorial lesions was associated with a higher proportion of central vein sign+ lesions (P = .002; P = .06, respectively).
CONCLUSIONS: Most cases of radiologically isolated syndrome had a high proportion of central vein sign+ lesions, suggesting that lesions in these individuals reflect perivenous inflammatory demyelination. Moreover, we found correlations between the proportion of central vein sign+ lesions and spinal cord lesions, a known risk factor for radiologically isolated syndrome progressing to MS. These findings raise the possibility, testable prospectively, that the central vein sign may have prognostic value in distinguishing patients with radiologically isolated syndrome at risk of developing clinical MS from those with white matter lesions of other etiologies.
ABBREVIATIONS:
- CVS
- central vein sign
- RIS
- radiologically isolated syndrome
Footnotes
Disclosures: Suradech Suthiphosuwan—UNRELATED: Grants/Grants Pending: Sanofi Genzyme, Comments: I received fellowship educational support from an unrestricted educational grant. Xavier Montalban–UNRELATED: X.M. Consultancy: Biogen, Celgene, Sanofi Genzyme, Merck, Novartis, Roche and Teva Pharmaceutical. Daniel S. Reich—UNRELATED: Expert Testimony: Leventhal & Puga, P.C. Jiwon Oh—RELATED: Grant: MS Society of Canada and Love/Barford Endowment*; UNRELATED: Consultancy: Biogen Idec, Roche, EMD Serono, Sanofi Genzyme, Celgene; Grants: Brain Canada, MS Society of Canada, Biogen Idec, Roche.* *Money paid to the institution.
This work was supported by the MS Society of Canada and the St. Michael's Hospital Foundation Love/Barford Endowment.
The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscripts; and the decision to submit the manuscript for publication.
Paper previously presented at: American Society of Neuroradiology Annual Meeting and the Foundation of the ASNR Symposium, June 2–7, 2018, Vancouver, British Columbia, Canada (abstract No. O-70).
- © 2019 by American Journal of Neuroradiology