New research in Neurology Open Access reported that central vein signs (CVS) on an MRI scan could diagnose multiple sclerosis (MS) without putting a patient through an invasive, “often painful” lumbar puncture (LP).
The research — “Comparison of the Diagnostic Performance of the Central Vein Sign and CSF Oligoclonal Bands Supporting the Diagnosis of Multiple Sclerosis” — was published in the peer-reviewed journal on May 16.
The study focuses on CVS, “the presence of venules” — very small veins — “within multiple sclerosis brain lesions” as visible on MRI scans. Study participants — 113 in all — who required a lumbar puncture to diagnose MS were enrolled “in this multicenter, prospective, diagnostic superiority study from three U.K. neuroscience centers.”
Finding six lesions containing a central venule “can support the diagnosis of MS as an alternative to lumbar puncture,” the study said.
Researchers also investigated “the tolerability of the LP and the additional MRI.” They added, “All participants preferred their MRI scan over their LP. … Compared with OCB [oligoclonal bands from a lumbar puncture] testing, CVS testing seems safer and better tolerated by patients.” Study authors noted that lumbar punctures “are associated with additional health-care costs such as hospitalization for monitoring, an anesthetist performing a blood patch, and time off work.
“The currently proposed modified diagnostic criteria introduce the central vein sign (CVS) as an imaging biomarker that can support the diagnosis of MS.”
Researchers said the presence of CVS “in white matter lesions is highly specific to MS, able to differentiate it from other neuroinflammatory diseases.” While initial studies looked for 40% of lesions with a central vein, “Later, the simplified ‘rule of six’ was introduced, which requires finding six lesions with a central vein to differentiate MS from non-MS.”
