The role of central vein sign in differential diagnostics of neuromyelitis optica spectrum disorders and multiple sclerosis

Advanced neuroimaging methods can improve the differential diagnosis of neuromyelitis optica spectrum disorders (NMOSD) and multiple sclerosis (MS). The presence of central vein sign (CVS) in areas of demyelination is a characteristic feature of MS and allows to distinguish this nosology from other diseases accompanied by changes in the white matter of the brain.

Objective: to evaluate the significance of detecting CVS on a 3.0 T MRI scanner during differential diagnosis between NMOSD and MS in real clinical practice.

Material and methods. The clinical picture and neuroimaging data (3.0 T MRI) of 19 patients aged 23 to 60 years (10 men and 9 women) were analysed. including nine patients with highly active MS (HAMS), four with NMOSD with antibodies to aquaporin-4 (AQP4), and six with demyelinating disease of the central nervous system (DD CNS), whose diagnosis required clarification. The average age of patients with MS was 30.6±4.9 years, with NMOSD – 52.3±5.1 years, and with DD CNS – 34.2±7.7 years. The average duration of the disease was 6.8±3.4 years for MS, 8.8±8.3 years for NMOSD, and 5.8±3.1 years for DD CNS. The Expanded Disability Status Scale (EDSS) was used to assess neurological status. In addition to the routine brain MRI protocol, 3D T2-FLAIR and 3D EPI SWI images were obtained. All images were taken before the contrast agent was administered. The data obtained were combined by superimposing T2-FLAIR images on SWI images in the MRViewer application of the Philips IntellispacePortal workstation with visual verification of the correctness of the alignment. Then, a qualitative analysis of the images was performed to identify foci along small venous vessels (CVS). CVS were assessed in lesions with a diameter of at least 3 mm located periventricularly or subcortically. Lesions in the artifact zone, infratentorial and juxtacortical were not evaluated. We used CVS as an auxiliary technique in the differential diagnosis of MS and NMOSD with the absence of AQP4 antibodies.

Results. The highest number of lesions with CVS (15.6±7.5) was observed in patients with MS, while in patients with NMOSD the number of cerebral lesions was minimal, and only one patient had a single lesion with CVS. A significant (p<0.05) difference was noted between the MS and NMOSD groups, as well as between the MS and DD CNS groups (6.5±5.3) in terms of the average number of lesions per patient and the median number of lesions per patient, as well as in terms of the average number of lesions with CVS between the MS and NMOSD groups, MS and DD CNS, NMOSD and DD CNS. As a result of the decision rule applied, the nosological diagnosis of MS or NMOSD was further refined, which made it possible to start pathogenetic therapy in the presented patients.

Conclusion. Within patients with NMOSD, the absence or small number of lesions with CVS may be an auxiliary differential diagnostic criterion with MS and DD CNS.

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