by Isabella Colonna
For January we have selected: Cagol A, Cortese R, Barakovic M, Schaedelin S, Ruberte E, Absinta M, Barkhof F, Calabrese M, Castellaro M, Ciccarelli O, Cocozza S, De Stefano N, Enzinger C, Filippi M, Jurynczyk M, Maggi P, Mahmoudi N, Messina S, Montalban X, Palace J, Pontillo G, Pröbstel AK, Rocca MA, Ropele S, Rovira À, Schoonheim MM, Sowa P, Strijbis E, Wattjes MP, Sormani MP, Kappos L, Granziera C; MAGNIMS Study Group. Diagnostic Performance of Cortical Lesions and the Central Vein Sign in Multiple Sclerosis. JAMA Neurol. 2023 Dec 11:e234737. doi: 10.1001/jamaneurol.2023.4737. Epub ahead of print. PMID: 38079177; PMCID: PMC10714285.
Different neurological conditions may mimic the clinical and radiological presentation of multiple sclerosis (MS); thus, a misdiagnosis represents an important risk in clinical practice.
This is a retrospective, multicentre, cross-sectional study aiming to evaluate the performance of cortical lesions (CL) and central vein sign (CVS) in differentiating multiple sclerosis from other conditions with brain white matter lesions. Inclusion criteria were diagnosis of multiple sclerosis (MS) or clinically isolated syndrome (CIS) as well as non-MS neurological disorders, the availability of a 3T brain MRI with a sequence suitable for the assessment of CL and CVS and the presence of T2-hyperintense white matter lesions. After screening for inclusion and exclusion criteria, 1051 patients were enrolled: 599 with CIS/MS and 452 with non-MS disorders (other neuroinflammatory conditions, cerebrovascular diseases, migraine, and incidental white matter lesions in healthy controls).
The authors found that the amount of CL and lesions with CVS was higher in CIS/MS patients than in the non-MS conditions. CL provided high specificity (95%) but low sensitivity (59%) for a diagnosis of MS, while the sensitivity and the specificity yielded by CVS were 78% and 86% respectively. The diagnostic power of the CVS was greater than that of CLs, while the combination of CL and CVS was more efficient than the single parameters alone in distinguishing CIS/MS from non-MS conditions. When the analysis was restricted to the patients with less than two years of disease duration, the diagnostic performance of CL, but not of CVS and of the combination of the two parameters, was reduced.
This study supports the use of CVS and CL in order to increase the accuracy of MS diagnosis. Prospective studies are needed to further explore the role of these two parameters in the differential diagnosis of MS.
