3T 中央静脉征对 MS 与血清阳性 NMOSD 的鉴别价值。
Value of the central vein sign at 3T to differentiate MS from seropositive NMOSD.
机构信息
From the NMR Research Unit (R.C., L.M., C.T., F.D., M.C.Y., F.P., F.B., O.C.), Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London; NMO Clinical Service at the Walton Centre (K.A.-A., A.J.), Liverpool; Translational Imaging Group (F.P., S.O., F.B.), Centre for Medical Image Computing (CMIC), Department of Medical Physics and Bioengineering, University College London; Lysholm Department of Neuroradiology (T.A.Y.), National Hospital for Neurology and Neurosurgery, London, UK; Department of Radiology and Nuclear Medicine (F.B.), MS Centre Amsterdam, VU Medical Centre Amsterdam, the Netherlands; and National Institute for Health Research (NIHR) (T.A.Y., F.B., O.C.), University College London Hospitals (UCLH) Biomedical Research Centre, London, UK.
出版信息
Neurology. 2018 Apr 3;90(14):e1183-e1190. doi: 10.1212/WNL.0000000000005256. Epub 2018 Mar 7.
OBJECTIVE
To assess the value of the central vein sign (CVS) on a clinical 3T scanner to distinguish between multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD).
METHODS
Eighteen aquaporin-4-antibody-positive patients with NMOSD, 18 patients with relapsing-remitting MS, and 25 healthy controls underwent 3T MRI. The presence of a central vein in white matter lesions on susceptibility-weighted imaging, defined as a thin hypointense line or a small dot, was recorded.
RESULTS
The proportion of lesions with the CVS was higher in MS than NMOSD (80% vs 32%, < 0.001). A greater proportion of lesions with the CVS predicted the diagnosis of MS, rather than NMOSD (odds ratio 1.10, 95% confidence interval [CI] 1.04 to 1.16, = 0.001), suggesting that each percent unit increase in the proportion of lesions with the CVS in an individual patient was associated with a 10% increase in the risk of the same patient having MS. If more than 54% of the lesions on any given scan show the CVS, then the patient can be given a diagnosis of MS with an accuracy of 94% (95% CIs 81.34, 99.32, < 0.001, sensitivity/specificity 90%/100%).
CONCLUSION
The clinical value of the CVS in the context of the differential diagnosis between MS and NMOSD, previously suggested using 7T scanners, is now extended to clinical 3T scanners, thereby making a step towards the use of CVS in clinical practice.
CLASSIFICATION OF EVIDENCE
This study provides Class III evidence that the CVS on 3T MRI accurately distinguishes patients with MS from those with seropositive NMOSD.
目的
评估临床 3T 扫描仪上中央静脉征（CVS）在鉴别多发性硬化症（MS）和视神经脊髓炎谱系障碍（NMOSD）中的价值。
方法
18 例抗水通道蛋白-4 抗体阳性 NMOSD 患者、18 例复发缓解型 MS 患者和 25 例健康对照者接受 3T MRI 检查。在磁敏感加权成像上记录脑白质病变中中央静脉的存在，表现为细低信号线或小点。
结果
MS 患者病变中 CVS 的比例高于 NMOSD（80%比 32%，<0.001）。具有 CVS 的病变比例较高提示诊断为 MS，而不是 NMOSD（比值比 1.10，95%置信区间 [CI] 1.04 至 1.16，=0.001），这表明个体患者 CVS 病变比例每增加 1 个单位，其患有 MS 的风险就会增加 10%。如果在任何给定的扫描中超过 54%的病变显示 CVS，则可以将该患者诊断为 MS，准确率为 94%（95%CI 81.34%，99.32%，<0.001，敏感性/特异性 90%/100%）。
结论
先前使用 7T 扫描仪提出的 CVS 在 MS 和 NMOSD 鉴别诊断中的临床价值现在已扩展到临床 3T 扫描仪，从而朝着在临床实践中使用 CVS 迈出了一步。
证据分类
本研究提供了 III 级证据，表明 3T MRI 上的 CVS 可准确区分 MS 患者和抗水通道蛋白-4 抗体阳性 NMOSD 患者。
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