Central vein sign differentiates Multiple Sclerosis from central nervous system inflammatory vasculopathies

被引：176

作者：

Maggi, Pietro ^{[1
,2
,3
]}

Absinta, Martina ^{[4
,5
,6
]}

Grammatico, Matteo ^{[7
]}

Vuolo, Luisa ^{[7
]}

Emmi, Giacomo ^{[8
]}

Carlucci, Giovanna ^{[9
]}

Spagni, Gregorio ^{[7
]}

Barilaro, Alessandro ^{[9
]}

Repice, Anna Maria ^{[9
]}

Emmi, Lorenzo ^{[10
]}

Prisco, Domenico ^{[10
]}

Martinelli, Vittorio ^{[5
]}

Scotti, Roberta ^{[11
]}

Sadeghi, Niloufar ^{[12
]}

Perrotta, Gaetano ^{[1
]}

Sati, Pascal ^{[4
]}

Dachy, Bernard ^{[2
]}

Reich, Daniel S. ^{[4
]}

Filippi, Massimo ^{[5
,6
]}

Massacesi, Luca ^{[7
,9
]}

机构：

[1] Univ Libre Bruxelles, Dept Neurol, Brussels, Belgium

[2] Univ Libre Bruxelles, Brugmann Univ Hosp, Dept Neurol, Brussels, Belgium

[3] Lausanne Univ Hosp, Dept Neurol, Lausanne, Switzerland

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

[5] Univ Vita Salute San Raffaele, Dept Neurol, Milan, Italy

[6] Univ Vita Salute San Raffaele, Inst Expt Neurol, Hosp San Raffaele, Neuroimaging Res Unit, Milan, Italy

[7] Univ Florence, Dept Neurosci Drug & Child Hlth, Florence, Italy

[8] Univ Florence, Careggi Univ Hosp, Ctr Rare Cardiovasc & Immunol Dis, Internal Interdisciplinary Med,Lupus Clin, Florence, Italy

[9] Univ Florence, Careggi Univ Hosp, Dept Neurol 2, Multiple Sclerosis Ctr, Florence, Italy

[10] Univ Florence, Dept Expt & Clin Med, Florence, Italy

[11] Univ Vita Salute San Raffaele, Dept Radiol, Milan, Italy

[12] Univ Libre Bruxelles, Erasme Univ Hosp, Dept Radiol, Brussels, Belgium

来源：

ANNALS OF NEUROLOGY | 2018年 / 83卷 / 02期

关键词：

WHITE-MATTER LESIONS; CLASSIFICATION CRITERIA; CONSENSUS STATEMENT; LUPUS-ERYTHEMATOSUS; PRIMARY ANGIITIS; DIAGNOSIS; DISEASE; MRI; MISDIAGNOSIS; MS;

D O I：

10.1002/ana.25146

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

ObjectivesIn multiple sclerosis (MS), magnetic resonance imaging (MRI) is a sensitive tool for detecting white matter lesions, but its diagnostic specificity is still suboptimal; ambiguous cases are frequent in clinical practice. Detection of perivenular lesions in the brain (the central vein sign) improves the pathological specificity of MS diagnosis, but comprehensive evaluation of this MRI biomarker in MS-mimicking inflammatory and/or autoimmune diseases, such as central nervous system (CNS) inflammatory vasculopathies, is lacking. In a multicenter study, we assessed the frequency of perivenular lesions in MS versus systemic autoimmune diseases with CNS involvement and primary angiitis of the CNS (PACNS). MethodsIn 31 patients with inflammatory CNS vasculopathies and 52 with relapsing-remitting MS, 3-dimensional T2*-weighted and T2-fluid-attenuated inversion recovery images were obtained during a single MRI acquisition after gadolinium injection. For each lesion, the central vein sign was evaluated according to consensus guidelines. For each patient, lesion count, volume, and brain location, as well as fulfillment of dissemination in space MRI criteria, were assessed. ResultsMS showed higher frequency of perivenular lesions (median=88%) than did inflammatory CNS vasculopathies (14%), without overlap between groups or differences between 3T and 1.5T MRI. Among inflammatory vasculopathies, Behcet disease showed the highest median frequency of perivenular lesions (34%), followed by PACNS (14%), antiphospholipid syndromes (12%), Sjogren syndrome (11%), and systemic lupus erythematosus (0%). When a threshold of 50% perivenular lesions was applied, central vein sign discriminated MS from inflammatory vasculopathies with a diagnostic accuracy of 100%. InterpretationThe central vein sign differentiates inflammatory CNS vasculopathies from MS at standard clinical magnetic field strengths. Ann Neurol 2018;83:283-294

引用

页码：283 / 294

页数：12

共 36 条

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