Lesion size and shape in central vein sign assessment for multiple sclerosis diagnosis: An in vivo and postmortem MRI study

Omar Al-Louzi, Sargis Manukyan, Maxime Donadieu, Martina Absinta, Vijay Letchuman, Brent Calabresi, Parth Desai, Erin S. Beck, Snehashis Roy, Joan Ohayon, Dzung L. Pham, Anish Thomas, Steven Jacobson, Irene Cortese, Pavan K. Auluck, Govind Nair, Pascal Sati, Daniel S. Reich

Research output: Contribution to journalArticlepeer-review


Background: The “central vein sign” (CVS), a linear hypointensity on T2*-weighted imaging corresponding to a central vein/venule, is associated with multiple sclerosis (MS) lesions. The effect of lesion-size exclusion criteria on MS diagnostic accuracy has not been extensively studied. Objective: Investigate the optimal lesion-size exclusion criteria for CVS use in MS diagnosis. Methods: Cross-sectional study of 163 MS and 51 non-MS, and radiological/histopathological correlation of 5 MS and 1 control autopsy cases. The effects of lesion-size exclusion on MS diagnosis using the CVS, and intralesional vein detection on histopathology were evaluated. Results: CVS+ lesions were larger compared to CVS− lesions, with effect modification by MS diagnosis (mean difference +7.7 mm3, p = 0.004). CVS percentage-based criteria with no lesion-size exclusion showed the highest diagnostic accuracy in differentiating MS cases. However, a simple count of three or more CVS+ lesions greater than 3.5 mm is highly accurate and can be rapidly implemented (sensitivity 93%; specificity 88%). On magnetic resonance imaging (MRI)-histopathological correlation, the CVS had high specificity for identifying intralesional veins (0/7 false positives). Conclusion: Lesion-size measures add important information when using CVS+ lesion counts for MS diagnosis. The CVS is a specific biomarker corresponding to intralesional veins on histopathology.

Original languageEnglish (US)
Pages (from-to)1891-1902
Number of pages12
JournalMultiple Sclerosis Journal
Issue number12
StatePublished - Oct 2022


  • Biomarkers
  • T2 lesions
  • central vein sign
  • magnetic resonance imaging
  • multiple sclerosis
  • post mortem

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology


Dive into the research topics of 'Lesion size and shape in central vein sign assessment for multiple sclerosis diagnosis: An in vivo and postmortem MRI study'. Together they form a unique fingerprint.

Cite this