Abdel Ghany Hend, Karam-Allah Ahmed, Edward Ramy, Abdel Naseer Maged, Hegazy Mohamed I
Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
Radiology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
Neuropsychiatr Dis Treat. 2022 Sep 1;18:1985-1992. doi: 10.2147/NDT.S377877. eCollection 2022.
Magnetic resonance imaging (MRI) findings in multiple sclerosis (MS) overlap with numerous MS mimics. The central vein sign (CVS) can help to differentiate MS from other mimics. This study aimed to determine the value of CVS as a diagnostic biomarker for distinguishing MS from its mimics.
Patients were prospectively recruited into two groups: a typical clinical (TC) MS presentation with an atypical MRI for MS and an atypical clinical (ATC) MS presentation with a typical MRI for MS. Patients underwent a 1.5T MRI brain scan with a T2*-weighted gradient-echo sequence. The presence of the central vein was assessed by a radiologist blinded to patients' clinical presentation. The MS consultant made the final diagnosis without reviewing the T2*-weighted gradient-echo sequence or the CVS analysis results.
Forty-two patients were included. Ten (40%) out of 25 TC patients were diagnosed with clinically definite MS (CDMS), with a mean percentage of CV-positive lesions of 65.5% among CDMS patients. Four (23.5%) out of 17 ATC patients were diagnosed with CDMS with a mean CV-positive lesions percentage of 68.25% among CDMS patients. TC patients who were not diagnosed as CDMS had a mean CV-positive lesions percentage of 10.13%, while ATC patients who were not diagnosed as CDMS had a mean CV-positive lesions percentage of 16.38%. The CVS showed 85.7% sensitivity and 100% specificity (95% confidence interval: 0.919-1.018) for diagnosis of MS at a cut off value of 45% ( < 0.001). The percentage of CV-positive lesions was significantly higher in oligoclonal bands (OCBs) positive patients compared to OCBs negative patients ( < 0.001) and those with spinal cord lesions compared to patients with no spinal cord lesions ( = 0.017).
The CVS has 85.7% sensitivity and 100% specificity for the diagnosis of MS at a cutoff value of 45%.
多发性硬化症（MS）的磁共振成像（MRI）表现与众多MS模拟疾病有重叠。中央静脉征（CVS）有助于将MS与其他模拟疾病区分开来。本研究旨在确定CVS作为区分MS与其模拟疾病的诊断生物标志物的价值。
前瞻性招募患者分为两组：具有非典型MS MRI表现的典型临床（TC）MS病例组和具有典型MS MRI表现的非典型临床（ATC）MS病例组。患者接受1.5T MRI脑部扫描，采用T2 *加权梯度回波序列。由对患者临床表现不知情的放射科医生评估中央静脉的存在情况。MS会诊医生在不查看T2 *加权梯度回波序列或CVS分析结果的情况下做出最终诊断。
纳入42例患者。25例TC患者中有10例（40%）被诊断为临床确诊的MS（CDMS），CDMS患者中CV阳性病变的平均百分比为65.5%。17例ATC患者中有4例（23.5%）被诊断为CDMS，CDMS患者中CV阳性病变的平均百分比为68.25%。未被诊断为CDMS的TC患者中CV阳性病变的平均百分比为10.13%，而未被诊断为CDMS的ATC患者中CV阳性病变的平均百分比为16.38%。在截断值为45%时，CVS对MS诊断的敏感性为85.7%，特异性为100%（95%置信区间：0.919 - 1.018）（P < 0.001）。与寡克隆带（OCBs）阴性患者相比，OCBs阳性患者中CV阳性病变的百分比显著更高（P < 0.001），与无脊髓病变的患者相比，有脊髓病变的患者中CV阳性病变的百分比更高（P = 0.017）。
在截断值为45%时，CVS对MS诊断的敏感性为85.7%，特异性为100%。
