Neuroimaging Research Unit, Division of Neuroscience.
Neurology Unit.
Curr Opin Neurol. 2021 Aug 1;34(4):505-513. doi: 10.1097/WCO.0000000000000946.
To summarize recent evidence from the application of susceptibility-based MRI sequences to investigate the 'central vein sign' (CVS) and 'iron rim' as biomarkers to improve the diagnostic work-up of multiple sclerosis (MS) and predict disease severity.
The CVS is a specific biomarker for MS being detectable from the earliest phase of the disease. A threshold of 40% of lesions with the CVS can be optimal to distinguish MS from non-MS patients. Iron rim lesions, reflecting chronic active lesions, develop in relapsing-remitting MS patients and persist in progressive MS. They increase in size in the first few years after their formation and then stabilize. Iron rim lesions can distinguish MS from non-MS patients but not the different MS phenotypes. The presence of at least four iron rim lesions is associated with an earlier clinical disability, higher prevalence of clinically progressive MS and more severe brain atrophy. Automated methods for CVS and iron rim lesion detection are under development to facilitate their quantification.
The assessment of the CVS and iron rim lesions is feasible in the clinical scenario and provides MRI measures specific to MS pathological substrates, improving diagnosis and prognosis of these patients.
总结应用基于磁化率的 MRI 序列来研究“中央静脉征”（CVS）和“铁环”作为生物标志物以提高多发性硬化症（MS）诊断并预测疾病严重程度的最新证据。
CVS 是 MS 的一个特异性生物标志物，在疾病的最早阶段即可检测到。具有 CVS 的病变超过 40%的阈值可作为区分 MS 和非 MS 患者的最佳标准。铁环病变反映了慢性活动性病变，在复发缓解型 MS 患者中发展，并在进展型 MS 中持续存在。它们在形成后的最初几年中会增大，然后稳定下来。铁环病变可将 MS 与非 MS 患者区分开来，但不能区分不同的 MS 表型。至少存在四个铁环病变与更早的临床残疾、更高的临床进展型 MS 患病率和更严重的脑萎缩相关。正在开发用于 CVS 和铁环病变检测的自动化方法，以方便其定量评估。
CVS 和铁环病变的评估在临床环境中是可行的，可提供针对 MS 病理底物的 MRI 指标，从而改善这些患者的诊断和预后。
