The “central vein sign” in patients with diagnostic “red flags” for multiple sclerosis: A prospective multicenter 3T study

Pietro Maggi, Martina Absinta, Pascal Sati, Gaetano Perrotta, Luca Massacesi, Bernard Dachy, Caroline Pot, Reto Meuli, Daniel S. Reich, Massimo Filippi, Renaud Du Pasquier, Marie Théaudin

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Background: The central vein sign (CVS) has been shown to help in the differential diagnosis of multiple sclerosis (MS), but most prior studies are retrospective. Objectives: To prospectively assess the diagnostic predictive value of the CVS in diagnostically difficult cases. Methods: In this prospective multicenter study, 51 patients with suspected MS who had clinical, imaging, or laboratory “red flags” (i.e. features atypical for MS) underwent 3T fluid-attenuated inversion recovery (FLAIR*) magnetic resonance imaging (MRI) for CVS assessment. After the diagnostic work-up, expert clinicians blinded to the results of the CVS assessment came to a clinical diagnosis. The value of the CVS to prospectively predict an MS diagnosis was assessed. Results: Of the 39 patients who received a clinical diagnosis by the end of the study, 27 had MS and 12 received a non-MS diagnosis that included systemic lupus erythematosus, sarcoidosis, migraine, Sjögren disease, SPG4-spastic-paraparesis, neuromyelitis optica, and Susac syndrome. The percentage of perivenular lesions was higher in MS (median = 86%) compared to non-MS (median = 21%; p < 0.0001) patients. A 40% perivenular lesion cutoff was associated with 97% accuracy and a 96% positive/100% negative predictive value. Conclusion: The CVS detected on 3T FLAIR* images can accurately predict an MS diagnosis in patients suspected to have MS, but with atypical clinical, laboratory, and imaging features.

Original languageEnglish (US)
Pages (from-to)421-432
Number of pages12
JournalMultiple Sclerosis Journal
Issue number4
StatePublished - Apr 1 2020


  • Central vein sign
  • MS diagnosis
  • red flags

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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