Kaisey Marwa, Solomon Andrew J, Guerrero Brooke L, Renner Brian, Fan Zhaoyang, Ayala Natalie, Luu Michael, Diniz Marcio A, Sati Pascal, Sicotte Nancy L
Cedars-Sinai Medical Center Department of Neurology, 127 S. San Vicente Blvd, Suite A6600, Los Angeles, CA 90048, USA.
Larner College of Medicine at the University of Vermont, Department of Neurological Sciences, 1 South Prospect Street, Arnold, Level 2, Burlington, Vermont 05401, USA.
Mult Scler Relat Disord. 2021 Feb;48:102671. doi: 10.1016/j.msard.2020.102671. Epub 2020 Dec 15.
Misdiagnosis of multiple sclerosis (MS) is common and often occurs due to misattribution of non-MS magnetic resonance imaging (MRI) lesions to MS demyelination. A recently developed MRI biomarker, the central vein sign (CVS), has demonstrated high specificity for MS lesions and may thus help prevent misdiagnosis.
This study explores the potential "real world" diagnostic value of CVS by comparing CVS in patients with MS and patients previously misdiagnosed with MS.
Fifteen patients with MS and 15 misdiagnosed with MS were prospectively recruited to undergo 3T brain MRI. T2-weighted fluid-attenuated inversion recovery (FLAIR) and T2*-weighted segmented echo-planar-imaging (T2*-EPI) were acquired. The generated FLAIR* images were analyzed by two independent raters. The percentage of lesions with CVS was calculated for each patient.
A CVS lesion threshold of 29% or higher resulted in high sensitivity (0.79) and specificity (0.88) for MS and correctly identified 87% of patients previously misdiagnosed with MS. Interrater reliability for CVS was high with a Cohen's kappa coefficient of 0.86.
This study demonstrates the ability of CVS to differentiate between patients with MS and patients with an MS misdiagnosis resulting from standard MRI and clinical evaluation. Clinical application of CVS may reduce MS misdiagnosis.
多发性硬化症（MS）的误诊很常见，通常是由于将非MS磁共振成像（MRI）病变误归因于MS脱髓鞘。最近开发的一种MRI生物标志物，即中央静脉征（CVS），已显示出对MS病变具有高特异性，因此可能有助于防止误诊。
本研究通过比较MS患者和先前被误诊为MS的患者的CVS，探讨CVS在“现实世界”中的潜在诊断价值。
前瞻性招募了15例MS患者和15例被误诊为MS的患者，进行3T脑部MRI检查。采集了T2加权液体衰减反转恢复（FLAIR）和T2加权分段回波平面成像（T2-EPI）。由两名独立的评估者分析生成的FLAIR*图像。计算每位患者具有CVS的病变百分比。
CVS病变阈值为29%或更高时，对MS具有高敏感性（0.79）和特异性（0.88），并正确识别了87%先前被误诊为MS的患者。CVS的评估者间可靠性很高，Cohen's kappa系数为0.86。
本研究证明了CVS能够区分MS患者和因标准MRI及临床评估而被误诊为MS的患者。CVS的临床应用可能会减少MS的误诊。
