Multiple sclerosis (Houndmills, Basingstoke, England) · 2026
Diagnostic performance of central vein sign and paramagnetic rim lesion integration for multiple sclerosis.
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Toljan Karlo, Renner Brian, Daboul Lynn, Martin Melissa L, Cao Quy, O'Donnell Carly M, Rodrigues Paulo, Derbyshire John, Azevedo Christina J, Bar-Or Amit, Caverzasi Eduardo, Calabresi Peter A, Cree Bruce A C, Freeman Leorah, Henry Roland G, Longbrake Erin E, Nakamura Kunio, Oh Jiwon, Papinutto Nico, Pelletier Daniel, Samudralwar Rohini D, Schindler Matthew K, Sotirchos Elias S, Sicotte Nancy L, Solomon Andrew J, Shinohara Russell T, Reich Daniel S, Sati Pascal, Ontaneda Daniel
Аннотация
BACKGROUND: The central vein sign (CVS) and the paramagnetic rim lesion (PRL) are neuroimaging biomarkers of multiple sclerosis (MS).
OBJECTIVES: To determine the diagnostic performance of CVS and PRL integration in people presenting for initial diagnostic evaluation of MS.
METHODS: Adults with clinical/radiological suspicion of MS, aged 18-65, with CVS and PRL assessment from the CentrAl Vein Sign in MS (CAVS-MS) pilot were included. Diagnostic performance of CVS and PRL combinations was evaluated, with 2017 McDonald criteria as the reference standard.
RESULTS: Seventy-eight participants were included (71% female, 86% white, 37 with MS). The combination of ⩾1 CVS and ⩾1 PRL demonstrated sensitivity/specificity of 0.76 (95% CI, 0.59, 0.88) and 0.93 (95% CI, 0.80, 0.98). The combination of ⩾6 CVS and ⩾1 PRL demonstrated sensitivity/specificity of 0.57 (95% CI, 0.39, 0.73) and 1.00 (95% CI, 0.91, 1.00). In those with cerebrospinal fluid testing (n = 46, 24 with MS), ⩾6 CVS and ⩾1 PRL diagnostic specificity was 1.00 (95% CI, 0.85, 1.00), similar to that of oligoclonal bands and dissemination in space by magnetic resonance imaging (0.82 [95% CI, 0.60, 0.95]).
DISCUSSION: Integrating CVS and PRL represents potentially advantageous MS diagnostic biomarkers, with increased specificity and without substantial reduction in sensitivity.
OBJECTIVES: To determine the diagnostic performance of CVS and PRL integration in people presenting for initial diagnostic evaluation of MS.
METHODS: Adults with clinical/radiological suspicion of MS, aged 18-65, with CVS and PRL assessment from the CentrAl Vein Sign in MS (CAVS-MS) pilot were included. Diagnostic performance of CVS and PRL combinations was evaluated, with 2017 McDonald criteria as the reference standard.
RESULTS: Seventy-eight participants were included (71% female, 86% white, 37 with MS). The combination of ⩾1 CVS and ⩾1 PRL demonstrated sensitivity/specificity of 0.76 (95% CI, 0.59, 0.88) and 0.93 (95% CI, 0.80, 0.98). The combination of ⩾6 CVS and ⩾1 PRL demonstrated sensitivity/specificity of 0.57 (95% CI, 0.39, 0.73) and 1.00 (95% CI, 0.91, 1.00). In those with cerebrospinal fluid testing (n = 46, 24 with MS), ⩾6 CVS and ⩾1 PRL diagnostic specificity was 1.00 (95% CI, 0.85, 1.00), similar to that of oligoclonal bands and dissemination in space by magnetic resonance imaging (0.82 [95% CI, 0.60, 0.95]).
DISCUSSION: Integrating CVS and PRL represents potentially advantageous MS diagnostic biomarkers, with increased specificity and without substantial reduction in sensitivity.