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Войти в исследования Multiple sclerosis and related disorders · 2026
Combining the central vein sign and paramagnetic rim lesions in the evaluation of multiple sclerosis misdiagnosis.
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Lee Joshua D, Renner Brian, Luskin Elaina, Guerrero Brooke L, Solomon Andrew J, Sicotte Nancy L, Sati Pascal, Kaisey Marwa
Аннотация
BACKGROUND: Emerging imaging biomarkers such as the central vein sign (CVS) and paramagnetic rim lesion (PRL) have high diagnostic specificity for multiple sclerosis (MS). Few studies have assessed whether combining these novel imaging biomarkers distinguishes patients with MS from those misdiagnosed with MS.
OBJECTIVES: To evaluate the diagnostic performance of CVS and PRLs, individually and in combination, for differentiating MS from patients misdiagnosed with MS in a prospectively recruited matched cohort study.
METHODS: Thirty patients referred to a tertiary MS center with a neurologist-assigned diagnosis of MS were prospectively recruited after independent expert consensus adjudication: 15 with confirmed MS and 15 with an alternative non-MS diagnosis (misdiagnosed). Brain MRI was evaluated for CVS and PRLs by blinded raters. Measures of diagnostic performance, including sensitivity and specificity, were calculated for CVS (Select6* criteria) and PRLs (≥1) as standalone and combined biomarkers.
RESULTS: The MS cohort had more CVS-positive (66.7%vs. 13.3%, p = 0.004) and PRL-positive (53.3%vs. 0%, p = 0.001) patients than the misdiagnosed cohort. Defining the combined test as positive when at least one of CVS or PRL was present yielded the highest sensitivity (73.3%, 95% CI: 51.0-95.7%). Requiring both biomarkers yielded 100% specificity but reduced sensitivity (46.7%, 95% CI: 21.4-71.9%).
CONCLUSION: Combined CVS and PRL assessment may provide complementary, supportive evidence in diagnostically challenging cases vulnerable to misdiagnosis.
OBJECTIVES: To evaluate the diagnostic performance of CVS and PRLs, individually and in combination, for differentiating MS from patients misdiagnosed with MS in a prospectively recruited matched cohort study.
METHODS: Thirty patients referred to a tertiary MS center with a neurologist-assigned diagnosis of MS were prospectively recruited after independent expert consensus adjudication: 15 with confirmed MS and 15 with an alternative non-MS diagnosis (misdiagnosed). Brain MRI was evaluated for CVS and PRLs by blinded raters. Measures of diagnostic performance, including sensitivity and specificity, were calculated for CVS (Select6* criteria) and PRLs (≥1) as standalone and combined biomarkers.
RESULTS: The MS cohort had more CVS-positive (66.7%vs. 13.3%, p = 0.004) and PRL-positive (53.3%vs. 0%, p = 0.001) patients than the misdiagnosed cohort. Defining the combined test as positive when at least one of CVS or PRL was present yielded the highest sensitivity (73.3%, 95% CI: 51.0-95.7%). Requiring both biomarkers yielded 100% specificity but reduced sensitivity (46.7%, 95% CI: 21.4-71.9%).
CONCLUSION: Combined CVS and PRL assessment may provide complementary, supportive evidence in diagnostically challenging cases vulnerable to misdiagnosis.