European Radiology: This MR sign is crucial for the diagnosis of multiple sclerosis!

From a clinical and imaging point of view, many lesions have features similar to those of multiple sclerosis (MS) , making the diagnosis of MS challenging .
In fact, despite the existence of specific diagnostic criteria, misdiagnosis remains a common problem in everyday clinical practice .
Indeed, while different iterations of the McDonald criteria showed increasing sensitivity, low specificity remained a problem .
For these reasons, the use of other biomarkers to assist in distinguishing MS from other lesions with similar signs has been explored clinically in recent years .

From a clinical and imaging point of view, many lesions have features similar to those of multiple sclerosis (MS) , making the diagnosis of MS challenging .

In fact, despite the existence of specific diagnostic criteria, misdiagnosis remains a common problem in everyday clinical practice .
Indeed, while different iterations of the McDonald criteria showed increasing sensitivity, low specificity remained a problem .
For these reasons, the use of other biomarkers to assist in distinguishing MS from other lesions with similar signs has been explored clinically in recent years .

Among the candidate biomarkers, a new neuroimaging sign , the central venous sign (CVS), helps differentiate MS from some diseases characterized by nonspecific white matter (WM) lesions, such as systemic lupus erythematosus ( SLE), antiphospholipid syndrome (APS), and Bechet disease .

The diagnostic significance of CVS is that perivascular inflammation plays a fundamental role in primary demyelination in multiple sclerosis, whereas the pathogenesis underlying many MS - like WM lesions (WMLs) is not the same .

Among the candidate biomarkers, a new neuroimaging sign , the central venous sign (CVS), helps differentiate MS from some diseases characterized by nonspecific white matter (WM) lesions, such as systemic lupus erythematosus ( SLE), antiphospholipid syndrome (APS), and Bechet disease .
The diagnostic significance of CVS is that perivascular inflammation plays a fundamental role in primary demyelination in multiple sclerosis, whereas the pathogenesis underlying many MS - like WM lesions (WMLs) is not the same .

Besides CVS, another promising biomarker with high specificity for MS is ferrous rim , a marginal paramagnetic alteration detectable at the margin of long-term active lesions , characterized by macrophages and microglia Plasma cells are the boundary .

Paramagnetic marginal lesions as an indicator of chronic neuroinflammation are valuable imaging biomarkers of disability progression .

Besides CVS, another promising biomarker with high specificity for MS is ferrous rim , a marginal paramagnetic alteration detectable at the margin of long-term active lesions , characterized by macrophages and microglia Plasma cells are the boundary .
Paramagnetic marginal lesions as an indicator of chronic neuroinflammation are valuable imaging biomarkers of disability progression .

In recent years, Fabry disease (FD) is a rare inherited lysosomal storage disorder characterized by the presence of WMLs and has many similarities to the MRI findings of MS .

Although the skin, kidneys, and cardiovascular system are commonly involved in the manifestations of FD, microvascular damage in the central nervous system may form multifocal and partially confluent WM hyperintensities similar to MS , which is one of the possible confounding factors in the differential diagnosis .

In recent years, Fabry disease (FD) is a rare inherited lysosomal storage disorder characterized by the presence of WMLs and has many similarities to the MRI findings of MS .
Although the skin, kidneys, and cardiovascular system are commonly involved in the manifestations of FD, microvascular damage in the central nervous system may form multifocal and partially confluent WM hyperintensities similar to MS , which is one of the possible confounding factors in the differential diagnosis .

A study published in the journal European Radiology assessed the incidence of CVS and lesions with iron ring signs in MS and FD and tested whether these neuroimaging signs are applicable to microvascular such as FD and MS in clinical practice.

Disease identification .
 

A study published in the journal European Radiology assessed the incidence of CVS and lesions with iron ring signs in MS and FD and tested whether these neuroimaging signs are applicable to microvascular such as FD and MS in clinical practice.
Disease identification .
 

This retrospective study evaluated MRI scans of 36 patients with FD and 73 patients with relapsing-remitting (RR) MS

Of all recorded neuroimaging signs, the difference was most pronounced in CVS, detectable in 78.

 

Figure all MRI signs analyzed in this study .
(a) Periventricular and deep white matter lesions, assessed with the Fazekas score; (b) corpus callosum involvement; (c) submeningeal involvement; (d) central vein sign, and (e) lesions with iron-positive rims .
 

Figure all MRI signs analyzed in this study .

(a) Periventricular and deep white matter lesions, assessed with the Fazekas score; (b) corpus callosum involvement; (c) submeningeal involvement; (d) central vein sign, and (e) lesions with iron-positive rims .
 Figure all MRI signs analyzed in this study .
(a) Periventricular and deep white matter lesions, assessed with the Fazekas score; (b) corpus callosum involvement; (c) submeningeal involvement; (d) central vein sign, and (e) lesions with iron-positive rims .
 

The results of this study confirm that CVS occurs at a high rate in multiple sclerosis, even in the early stages of the disease, and that CVS does not appear to exist in the context of different etiologies
.

The results of this study confirm the diagnostic value of CVS as a valuable neuroimaging marker suggestive of multiple sclerosis

The results of this study confirm that CVS occurs at a high rate in multiple sclerosis, even in the early stages of the disease, and that CVS does not appear to exist in the context of different etiologies

Original source :

Mario Tranfa , Mario Tortora , Giuseppe Pontillo , et al .

The central vein sign helps in differentiating multiple sclerosis from its mimickers: lessons from Fabry disease.
DOI: 10.

Mario Tranfa Mario Tortora Giuseppe Pontillo ,et al 10.
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