Diagnostic and interventional radiology (Ankara, Turkey) · 2026
Added diagnostic value of postcontrast susceptibility-weighted imaging with 1.5-Tesla magnetic resonance imaging for central vein sign assessment in multiple sclerosis.
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Atalay Başak, Yamer Mizgin, Doğan Mahmut Bilal
Аннотация
PURPOSE: This study aimed to assess whether post-contrast susceptibility-weighted imaging (SWI) at 1.5-T improves visualization of the central vein sign (CVS) in multiple sclerosis (MS) lesions.
METHODS: In this prospective observational study, 30 patients with MS underwent 1.5-T brain magnetic resonance imaging (MRI), including pre-contrast SWI (SWI-C) and post-contrast SWI (SWI+C) sequences. Lesions were evaluated for location, contrast enhancement, and the presence of CVS and paramagnetic rim lesions (PRLs). Counts of CVS- and PRL-positive lesions were compared between SWI-C and SWI+C using the Wilcoxon signed-rank test, and the proportion of patients meeting the select-6 criterion was assessed with McNemar's test. Additional analyses using alternative thresholds (select-3 and > 50%) were performed to evaluate CVS positivity across different criteria. Correlations with Expanded Disability Status Scale (EDSS) scores were assessed using Spearman's rank correlation.
RESULTS: The cohort included 24 women (80%) with a mean age of 39.6 ± 12.5 years. There was a significant increase in CVS counts on SWI+C compared with SWI-C (P < 0.01). Across patients, the mean number of CVS was 5 (range: 0-14) on SWI-C and 6 (range: 0-19) on SWI+C. SWI+C demonstrated increased CVS in 20/30 patients (66.7%), with Wilcoxon signed-rank testing confirming a significant difference between pre- and post-contrast counts (P < 0.01). According to the select-6 criterion, CVS positivity increased from 14/30 (46.7%) pre-contrast to 20/30 (66.7%) post-contrast (P = 0.031), corresponding to 6 additional patients classified as CVS-positive, indicating improved detection with contrast-enhanced imaging. Using alternative thresholds, CVS positivity remained unchanged with the select-3 criterion (76.7% in both), whereas a > 50% threshold showed an increase from 13.3% to 30.0%, although fewer patients were identified compared with the select-6 method. The mean PRL count did not significantly change following contrast administration (P = 0.18). No significant correlations were observed between EDSS, CVS, or PRL counts on either SWI-C or SWI+C.
CONCLUSION: SWI+C at 1.5-T significantly enhances the detection of the CVS in MS lesions without substantially affecting PRL visualization, suggesting its practical value for routine clinical assessment of CVS.
CLINICAL SIGNIFICANCE: SWI+C at 1.5-T, a widely accessible MRI field strength, enhances detection of the CVS in MS lesions, potentially improving diagnostic specificity in routine practice.
METHODS: In this prospective observational study, 30 patients with MS underwent 1.5-T brain magnetic resonance imaging (MRI), including pre-contrast SWI (SWI-C) and post-contrast SWI (SWI+C) sequences. Lesions were evaluated for location, contrast enhancement, and the presence of CVS and paramagnetic rim lesions (PRLs). Counts of CVS- and PRL-positive lesions were compared between SWI-C and SWI+C using the Wilcoxon signed-rank test, and the proportion of patients meeting the select-6 criterion was assessed with McNemar's test. Additional analyses using alternative thresholds (select-3 and > 50%) were performed to evaluate CVS positivity across different criteria. Correlations with Expanded Disability Status Scale (EDSS) scores were assessed using Spearman's rank correlation.
RESULTS: The cohort included 24 women (80%) with a mean age of 39.6 ± 12.5 years. There was a significant increase in CVS counts on SWI+C compared with SWI-C (P < 0.01). Across patients, the mean number of CVS was 5 (range: 0-14) on SWI-C and 6 (range: 0-19) on SWI+C. SWI+C demonstrated increased CVS in 20/30 patients (66.7%), with Wilcoxon signed-rank testing confirming a significant difference between pre- and post-contrast counts (P < 0.01). According to the select-6 criterion, CVS positivity increased from 14/30 (46.7%) pre-contrast to 20/30 (66.7%) post-contrast (P = 0.031), corresponding to 6 additional patients classified as CVS-positive, indicating improved detection with contrast-enhanced imaging. Using alternative thresholds, CVS positivity remained unchanged with the select-3 criterion (76.7% in both), whereas a > 50% threshold showed an increase from 13.3% to 30.0%, although fewer patients were identified compared with the select-6 method. The mean PRL count did not significantly change following contrast administration (P = 0.18). No significant correlations were observed between EDSS, CVS, or PRL counts on either SWI-C or SWI+C.
CONCLUSION: SWI+C at 1.5-T significantly enhances the detection of the CVS in MS lesions without substantially affecting PRL visualization, suggesting its practical value for routine clinical assessment of CVS.
CLINICAL SIGNIFICANCE: SWI+C at 1.5-T, a widely accessible MRI field strength, enhances detection of the CVS in MS lesions, potentially improving diagnostic specificity in routine practice.