Belov S E, Boyko A N, Dolgushin M B
Pirogov Russian National Research Medical University, Moscow, Russia.
Federal Center for Brain Research and Neurotechnology, Moscow, Russia.
Zh Nevrol Psikhiatr Im S S Korsakova. 2024;124(7. Vyp. 2):58-65. doi: 10.17116/jnevro202412407258.
To carry out a clinical and radiological assessment of the central vein sign (CVS) as a diagnostic marker for multiple sclerosis (MS) and other demyelinating and non-demyelinating diseases with focal brain damage, using clinical and laboratory examination data, as well as MRI.
The results of clinical and neuroradiological examination of 107 patients diagnosed with MS or with other diseases accompanied by focal brain damage according to MRI data were analyzed.
CVS is a sensitive but low-specific diagnostic marker of MS. According to our data, the sensitivity and specificity of 40 and 50% of the threshold of perivenular lesions in the diagnosis of MS are the same and amount to 100% and 39.4%, respectively. Neither the type of MS course, nor the severity of the course, nor the intake of DMT (disease modifying treatment), affect the proportion of foci with CVS. The spread of the proportion of foci with CVS in patients with MS was 60-100%. The proportion of foci with CVS is below 40 and 50% of the threshold in patients with demyelinating and non-demyelinating diseases (NMOSD, migraine, systemic lupus erythematosus, Susak disease, CLIPPERS), which allows for differential diagnosis with MS. The proportion of foci with CVS comparable to MS in patients with acute disseminated encephalomyelitis, small vessel disease, as well as in patients with radiologically isolated syndrome does not allow using this symptom in the differential diagnosis of these conditions.
The use of CVS as a diagnostic marker of MS is possible only in combination with the already existing diagnostic criteria of MS.
利用临床和实验室检查数据以及磁共振成像（MRI），对中央静脉征（CVS）作为多发性硬化（MS）以及其他伴有局灶性脑损伤的脱髓鞘和非脱髓鞘疾病的诊断标志物进行临床和影像学评估。
分析了107例根据MRI数据诊断为MS或患有其他伴有局灶性脑损伤疾病的患者的临床和神经放射学检查结果。
CVS是MS的一个敏感但特异性较低的诊断标志物。根据我们的数据，在MS诊断中，静脉周围病变阈值的40%和50%时的敏感性和特异性相同，分别为100%和39.4%。MS病程类型、病程严重程度以及疾病修正治疗（DMT）的使用均不影响出现CVS病灶的比例。MS患者中出现CVS病灶的比例范围为60%-100%。在脱髓鞘和非脱髓鞘疾病（视神经脊髓炎谱系疾病、偏头痛、系统性红斑狼疮、苏萨克病、慢性淋巴细胞性炎症伴脑桥血管周围强化症）患者中，出现CVS病灶的比例低于阈值的40%和50%，这有助于与MS进行鉴别诊断。在急性播散性脑脊髓炎、小血管疾病以及放射学孤立综合征患者中，出现CVS病灶的比例与MS相当，因此无法利用这一症状对这些疾病进行鉴别诊断。
仅将CVS作为MS的诊断标志物使用时，必须结合现有的MS诊断标准。
