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| Item Type: | Article |
|---|---|
| Title: | Prevalence of the central vein sign on susceptibility-weighted imaging in people with pediatric-onset multiple sclerosis |
| Creators Name: | Kuchling, Joseph, Koukou, Georgia, Bartels, Frederik, Cleaveland, Robert, Wegener-Panzer, Andreas, Gowert, Thomas, El Naggar, Ines, Bertolini, Annikki, Paul, Friedemann, Rostásy, Kevin and Finke, Carsten |
| Abstract: | BACKGROUND AND OBJECTIVES: iven the high sensitivity but only moderate specificity of current diagnostic criteria for multiple sclerosis (MS), novel diagnostic biomarkers for pediatric-onset MS (POMS) are highly warranted. The central vein sign (CVS) is a such promising MRI biomarker candidate that has been shown to distinguish MS from other neuroimmunologic diseases with high specificity. The aim of this study was to assess the prevalence of the CVS in POMS under real-world conditions by analyzing T2-hyperintense lesions using 1.5T susceptibility-weighted imaging (SWI). METHODS: We retrospectively reviewed clinical MRI scans acquired at 1.5T in patients with POMS based on International Paediatric Multiple Sclerosis Study Group criteria and 2017 McDonald criteria at first clinical presentation. Each examination included (1) fluid-attenuated inversion recovery in sagittal, axial, or coronal plane and (2) SWI sequences obtained in the axial plane. Lesions with diameters >3 mm were assessed for CVS according to the North American Imaging in Multiple Sclerosis Cooperative criteria, and Select6* criteria were applied in every patient by 2 experienced raters. RESULTS: We assessed 31 POMS patients (mean age 13.8 ± 2.6 years; 81% female) with 4 children initially diagnosed as patients with radiologically isolated syndrome (RIS). In total, 535 of 605 T2-hyperintense cerebral lesions were assessable for CVS evaluation, corresponding to a median number of 14 (IQR: 6–21], range 2–57) lesions per patient adequate for CVS assessment. Most lesions were characterized as periventricular (n = 201 [37.6%]), while 20 cortical lesions (3.7%) were detected. The median individual CVS percentage per patient was 75% (IQR: 70%–82%). All POMS patients exhibited a CVS percentage above 40% and fulfilled Select6* criteria, including those investigated at the time of RIS. DISCUSSION: CVS was frequently observed in T2-hyperintense lesions of patients with POMS, consistent with the proposed MS-specific Select6* criteria and above the 40% cutoff, despite the use of heterogeneous MRI protocols at 1.5T under real-world clinical conditions. SWI at 1.5T may therefore hold the potential to increase the specificity of MS diagnostic criteria also in pediatric patients. |
| Source: | Neurology Open Access |
| ISSN: | 2998-7601 |
| Publisher: | American Academy of Neurology |
| Volume: | 1 |
| Number: | 3 |
| Page Range: | e000031 |
| Date: | September 2025 |
| Official Publication: | https://doi.org/10.1212/WN9.0000000000000031 |
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