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Central Vein Sign, Cortical Lesions, and Paramagnetic Rim Lesions for the Diagnostic and Prognostic Workup of Multiple Sclerosis
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BACKGROUND AND OBJECTIVES: The diagnosis of multiple sclerosis (MS) can be challenging in clinical practice because MS presentation can be atypical and mimicked by other diseases. We evaluated the diagnostic performance, alone or in combination, of the central vein sign (CVS), paramagnetic rim lesion (PRL), and cortical lesion (CL), as well as their association with clinical outcomes. METHODS: In this multicenter observational study, we first conducted a cross-sectional analysis of the CVS (proportion of CVS-positive lesions or simplified determination of CVS in 3/6 lesions-Select3*/Select6*), PRL, and CL in MS and non-MS cases on 3T-MRI brain images, including 3D T2-FLAIR, T2*-echo-planar imaging magnitude and phase, double inversion recovery, and magnetization prepared rapid gradient echo image sequences. Then, we longitudinally analyzed the progression independent of relapse and MRI activity (PIRA) in MS cases over the 2 years after study entry. Receiver operating characteristic curves were used to test diagnostic performance and regression models to predict diagnosis and clinical outcomes. RESULTS: = 0.008), whereas no association was observed between other baseline MRI measures and PIRA, including the number of CL. DISCUSSION: The combination of CVS, CL, and PRL can improve MS differential diagnosis. CL and PRL also correlated with clinical measures of poor prognosis, with PRL being a predictor of disability accrual independent of clinical/MRI activity.
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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 [32]
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Experimental — accuracy not yet measuredTechnical 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 [32]
The Methods (MRI Acquisition; Image Processing and Biomarker Assessment, page not provided) describe specialized MRI sequences and assessments by trained investigators. The Discussion also cautions that the diagnostic tool relies on this study’s specific imaging protocol. The paper does not say that neuroradiologist training is needed to improve diagnostic certainty or that these demands currently limit the markers’ availability. (LLM, conf=0.83)
Experimental — accuracy not yet measuredStudies 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 [32]
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From routine to selective: how updated MRI guidelines reshape gadolinium use in Germany
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“…of the missed MS diagnoses could have been made, possibly reaching a similar proportion of MS diagnosis as compared with detection of KFLC. 11,12,32,33 However, CSF analysis in general and detection of CSF-restricted oligoclonal bands in special are pivotal for differential diagnosis beyond the…”
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Self-citation
Metadata
- Authors
- Borrelli, S., Martire, M. S., Stölting, A., Vanden Bulcke, C., Pedrini, E., Guisset, F., Bugli, C., Yildiz, H., Pothen, L., Elands, S., Martinelli, V., Smith, B., Jacobson, S., Du Pasquier, R. A., Van Pesch, V., Filippi, M., Reich, D. S., Absinta, M., & Maggi, P.
- Affiliations
- Université Libre de Bruxelles (BE)
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve,...
- Corresponding author
- Maggi, Pietro
- ORCID
- Venue
- Neurology Neuroimmunology & Neuroinflammation
- Published
- 2024-07
- Volume
- 11
- Issue
- 4
- Pages
- e200253-e200253
- ISSN
- 2332-7812 (ISSN-L)
- PMC
- PMC11129678
- OpenAlex
- W4398770545
- Cited by
- 61
- References
- 61
- Citations by year
- 2026: 32 · 2025: 24 · 2024: 5
- FWCI
- 18.55
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Neurology Neuroimmunology & Neuroinflammation (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion, other-oa)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion, cc-by-nc-nd)
- SERVAL (Université de Lausanne) (submittedVersion, cc-by-nc-nd)
- Digital Access to Libraries (submittedVersion, other-oa)
- IRIS (submittedVersion, cc-by-nc-nd)
- Funders
- Conrad N. Hilton Foundation
- Sanofi
- Biogen
- Fondazione Italiana Sclerosi Multipla
- International Progressive MS Alliance
- Fonds De La Recherche Scientifique - FNRS
- Fondazione Cariplo
- Ministero della Salute
- Koning Boudewijnstichting
- Fondation Charcot
- Fonds Spéciaux de Recherche
- Brugmann Foundation
- National Institutes of Health
- National Institute of Neurological Disorders and Stroke
- Cliniques Universitaires Saint-Luc
- Topics
- Health Sciences › Medicine › Clinical Neurology › Multiple Sclerosis Research Studies
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced MRI Techniques and Applications
- Health Sciences › Medicine › Oncology › Polyomavirus and related diseases
- Keywords
- multiple sclerosis, central vein sign, paramagnetic rim lesions, cortical lesions, MRI lesion characteristics, differential diagnosis, progression independent of relapse activity, disability progression, prognosis, T2-weighted imaging, T2-FLAIR
- MeSH terms
- Adult, Cerebral Cortex, Cerebral Veins, Cross-Sectional Studies, Female, Humans, Longitudinal Studies, Magnetic Resonance Imaging, Male, Middle Aged, Multiple Sclerosis, Prognosis, Disease Progression
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