Central vein sign and paramagnetic rim lesion abbreviated counting methods for diagnosis of multiple sclerosis: a systematic review and meta-analysis
Open accessAbstract
Aim The central vein sign (CVS) and paramagnetic rim lesion (PRL) are neuroimaging biomarkers in multiple sclerosis (MS). Abbreviated CVS methods are an alternative to percentage-based approaches. The pooled diagnostic performance of Select-3 (≥3 CVS + lesions), Select-6 (≥6 CVS + lesions), and PRL (≥1 lesion) is unknown. To summarise the diagnostic performance of CVS and PRL abbreviated methods forMS. Materials and methods We conducted a systematic review and meta-analysis for studies that included two common abbreviated CVS methods (Select-3, Select-6), and/or ≥1 PRL. The search was conducted in PubMed, Scopus, and Web of Science. Studies were included if the sample consisted of participants with MS and controls, and if the diagnostic performance of CVS and/or PRL was extractable. Quality was determined according to the QUADAS-2 tool. Meta-analysis was performed with a hierarchical model. Prespecified sensitivity analyses were conducted. Publication bias was assessed with Deeks' plot. Resuts Twenty-nine studies were included. Select-3 was available in 14 studies, Select-6 in 12 studies, and PRL in 17 studies. For Select-3, pooled sensitivity was 0.88 (0.79-0.94) and specificity was 0.77 (0.65-0.86), for Select-6 0.82 (0.70-0.89) and 0.89 (0.82-0.94), and for ≥1 PRL 0.56 (0.42-0.69) and 0.99 (0.95-1.00). Quality was impacted by risk of bias due to patient selection (10/15 CVS studies, 15/17 PRL studies). Conclusion Select-6 and PRL are specific for MS, while Select-3 is sens…
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Technical demands in the acquisition process as well as the need for training of neuroradiologists to improve diagnostic certainty limits the availability of novel MRI markers at present.
“Furthermore, technical demands in the acquisition process as well as the need for training of neuroradiologists to improve diagnostic certainty limits the availability of these novel MRI markers at present.”
From Applying the 2024-revised McDonald criteria for multiple sclerosis using conventional diagnostic tools: a single-centre prospective cohort study in Germany (2026) · cites this paper as [33]
Studies employing the select-6∗ methodology for CVS have reported high sensitivity and specificity for distinguishing MS from mimics.
“studies employing the select-6∗ methodology for CVS have reported high sensitivity and specificity for distinguishing MS from mimics”
From Applying the 2024-revised McDonald criteria for multiple sclerosis using conventional diagnostic tools: a single-centre prospective cohort study in Germany (2026) · cites this paper as [33]
When applying the published diagnostic sensitivity of the select-6∗ methods of 82%-89%, hypothetically some of the missed MS diagnoses could have been made, possibly reaching a similar proportion of MS diagnosis as compared with detection of KFLC.
“When applying the published diagnostic sensitivity of the select-6∗ methods of 82%–89%, hypothetically some of the missed MS diagnoses could have been made, possibly reaching a similar proportion of MS diagnosis as compared with detection of KFLC.”
From Applying the 2024-revised McDonald criteria for multiple sclerosis using conventional diagnostic tools: a single-centre prospective cohort study in Germany (2026) · cites this paper as [33]
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- Authors
- Toljan, K., Amin, M., & Ontaneda, D.
- Affiliations
- Cleveland Clinic (US)
- Corresponding author
- Toljan, K.
- Venue
- Clinical Radiology
- Publisher
- Elsevier BV
- Published
- 2025-09
- Volume
- 88
- Pages
- 106984
- ISSN
- 0009-9260 (ISSN-L)
- OpenAlex
- W4411200798
- Cited by
- 9
- References
- 55
- Citations by year
- 2026: 8 · 2025: 1
- FWCI
- 1.54
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Clinical Radiology (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- Bristol-Myers Squibb
- Biogen
- Race to Erase MS
- Multiple Sclerosis Society
- Genentech
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced MRI Techniques and Applications
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Keywords
- multiple sclerosis, central vein sign, diagnostic accuracy, sensitivity and specificity, neuroimaging biomarkers, brain MRI
- MeSH terms
- Brain, Cerebral Veins, Humans, Magnetic Resonance Imaging, Multiple Sclerosis, Sensitivity and Specificity, Neuroimaging
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