Effect of GBCA Use on Detection and Diagnostic Performance of the Central Vein Sign: Evaluation Using a 3-T FLAIR* Sequence in Patients With Suspected Multiple Sclerosis

被引：12

作者：

Daboul, Lynn ^{[1
,2
,3
]}

O'Donnell, Carly M. ^{[4
]}

Cao, Quy ^{[4
]}

Amin, Moein ^{[5
]}

Rodrigues, Paulo ^{[6
]}

Derbyshire, John ^{[7
]}

Azevedo, Christina ^{[8
]}

Bar-Or, Amit ^{[9
]}

Caverzasi, Eduardo ^{[10
]}

Calabresi, Peter ^{[11
]}

Cree, Bruce A. C. ^{[10
]}

Freeman, Leorah ^{[12
]}

Henry, Roland G. ^{[10
]}

Longbrake, Erin E. ^{[13
]}

Nakamura, Kunio ^{[14
]}

Oh, Jiwon ^{[15
]}

Papinutto, Nico ^{[10
]}

Pelletier, Daniel ^{[8
]}

Samudralwar, Rohini D. ^{[16
]}

Suthiphosuwan, Suradech ^{[17
]}

Schindler, Matthew K. ^{[9
]}

Sotirchos, Elias S. ^{[11
]}

Sicotte, Nancy L. ^{[18
]}

Solomon, Andrew J. ^{[19
]}

Shinohara, Russell T. ^{[4
]}

Reich, Daniel S. ^{[2
]}

Ontaneda, Daniel ^{[20
]}

Sati, Pascal ^{[2
,18
]}

机构：

[1] Brigham & Womens Hosp, Dept Neurol, 75 Francis St, Boston, MA 02115 USA

[2] NINDS, Translat Neuroradiol Sect, NIH, Bldg 36,Rm 4D04, Bethesda, MD 20892 USA

[3] Cleveland Clin, Lerner Coll Med, Cleveland, OH 44106 USA

[4] Univ Penn, Perelman Sch Med, Penn Stat Imaging & Visualizat Ctr, Dept Biostat Epidemiol & Informat, Philadelphia, PA 19104 USA

[5] Cleveland Clin, Neurol Inst, Cleveland, OH 44106 USA

[6] QMENTA Inc, Boston, MA USA

[7] NIMH, Funct MRI Facil, NIH, Bethesda, MD 20892 USA

[8] Univ Southern Calif, Dept Neurol, Los Angeles, CA 90007 USA

[9] Univ Penn, Perelman Sch Med, Dept Neurol, Philadelphia, PA 19104 USA

[10] Univ Calif San Francisco, Dept Neurol, San Francisco, CA 94143 USA

[11] Johns Hopkins Univ, Dept Neurol, Baltimore, MD 21218 USA

[12] Univ Texas Austin, Dell Med Sch, Dept Neurol, Austin, TX 78712 USA

[13] Yale Univ, Dept Neurol, New Haven, CT USA

[14] Cleveland Clin, Lerner Res Inst, Dept Biomed Engn, Cleveland, OH 44106 USA

[15] Univ Toronto, St Michaels Hosp, Div Neurol, Toronto, ON, Canada

[16] Univ Texas Hlth Sci Ctr Houston, Dept Neurol, Houston, TX 77030 USA

[17] Univ Toronto, St Michaels Hosp, Dept Med Imaging, Toronto, ON, Canada

[18] Cedars Sinai Med Ctr, Dept Neurol, Los Angeles, CA 90048 USA

[19] Univ Vermont, Larner Coll Med, Dept Neurol Sci, Burlington, VT USA

[20] Cleveland Clin, Mellen Ctr Multiple Sclerosis, Cleveland, OH 44106 USA

来源：

AMERICAN JOURNAL OF ROENTGENOLOGY | 2023年 / 220卷 / 01期

基金：

美国国家卫生研究院;

关键词：

central vein sign; FLAIR(x); gadolinium; -multiple sclerosis; WHITE-MATTER LESIONS; BRAIN-LESIONS; MS LESIONS; MRI; DIFFERENTIATION; MISDIAGNOSIS; GUIDELINES;

D O I：

10.2214/AJR.22.27731

中图分类号：

R8 [特种医学]; R445 [影像诊断学];

学科分类号：

1002 ; 100207 ; 1009 ;

摘要：

BACKGROUND. The central vein sign (CVS) is a proposed MRI biomarker of multiple sclerosis (MS). The impact of gadolinium-based contrast agent (GBCA) administration on CVS evaluation remains poorly investigated. OBJECTIVE. The purpose of this study was to assess the effect of GBCA use on CVS detection and on the diagnostic performance of the CVS for MS using a 3-T FLAIR* sequence. METHODS. This study was a secondary analysis of data from the pilot study for the prospective multicenter Central Vein Sign: A Diagnostic Biomarker in Multiple Sclerosis (CAVS-MS), which recruited adults with suspected MS from April 2018 to February 2020. Participants underwent 3-T brain MRI including FLAIR and precontrast and postcontrast echo-planar imaging T2*-weighted acquisitions. Postprocessing was used to generate combined FLAIR and T2*-weighted images (hereafter, FLAIR*). MS diagnoses were established using the 2017 McDonald criteria. Thirty participants (23 women, seven men; mean age, 45 years) were randomly selected from the CAVS- MS pilot study cohort. White matter lesions (WMLs) were marked using FLAIR* images. A single observer, blinded to clinical data and GBCA use, reviewed marked WMLs on FLAIR* images for the presence of the CVS. RESULTS. Thirteen of 30 participants had MS. Across participants, on precontrast FLAIR* imaging, 218 CVS-positive and 517 CVS-negative WMLs were identified; on postcontrast FLAIR* imaging, 269 CVS-positive and 459 CVS-negative WMLs were identified. The fraction of WMLs that were CVS-positive on precontrast and postcontrast images was 48% and 58% in participants with MS and 7% and 10% in participants without MS, respectively. The median patient-level CVS-positivity rate on precontrast and postcontrast images was 43% and 67% for participants with MS and 4% and 8% for participants without MS, respectively. In a binomial model adjusting for MS diagnoses, GBCA use was associated with an increased likelihood of at least one CVS-positive WML (odds ratio, 1.6; p <.001). At a 40% CVS-positivity threshold, the sensitivity of the CVS for MS increased from 62% on precontrast images to 92% on postcontrast images ( p =.046). Specificity was not significantly different between precontrast (88%) and postcontrast (82%) images (p =.32). CONCLUSION. GBCA use increased CVS detection on FLAIR* images, thereby increasing the sensitivity of the CVS for MS diagnoses. CLINICAL IMPACT. The postcontrast FLAIR* sequence should be considered for CVS evaluation in future investigational trials and clinical practice.

引用

页码：115 / 125

页数：11

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