Central vein sign and paramagnetic rim lesions in Multiple Sclerosis diagnosis

New MRI biomarkers are becoming increasingly relevant in the diagnosis of Multiple Sclerosis (MS). Among them, the central vein sign (CVS) and paramagnetic rim lesions (PRLs) can improve diagnostic specificity and help distinguish MS from conditions that may mimic the disease.

Šarlota Mesaroš reviews the biological basis, MRI detection and clinical relevance of these two biomarkers, and explains how they are incorporated into the revised McDonald diagnostic criteria.

Key Insights from the Lecture:

• The central vein sign reflects a characteristic pathobiological feature of Multiple Sclerosis that can now be visualized using appropriate MRI sequences.
• CVS-positive lesions are more frequent in MS than in several MS mimics, supporting its role as a highly specific diagnostic biomarker.
• In clinical practice, the Select-6 approach can be used instead of calculating the percentage of CVS-positive lesions.
• Under this approach, the presence of at least six lesions showing the central vein sign supports CVS positivity.
• When fewer than six lesions are present, CVS-positive lesions should outnumber CVS-negative lesions.
• Paramagnetic rim lesions represent chronic active lesions with iron-containing macrophages and microglia at the lesion edge.
• PRLs require susceptibility-based MRI sequences for detection.The presence of at least one PRL may provide high specificity when distinguishing MS from other central nervous system disorders that can mimic the disease.
• PRLs can be present early in the disease course, including in Radiologically Isolated Syndrome and pediatric MS.
• The revised diagnostic framework does not require CVS or PRLs for every diagnosis, but both can provide important additional diagnostic information.
• These biomarkers may help increase diagnostic specificity when conventional criteria are not sufficient.
• CVS may also contribute to demonstrating dissemination in time in selected diagnostic situations.
• Updated MRI recommendations include susceptibility-sensitive sequences to support detection of both CVS and PRLs.

“Central vein sign and paramagnetic rim lesions in Multiple Sclerosis diagnosis”

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About the speaker:

Šarlota Mesaroš

Professor of Neurology at the Faculty of Medicine, University of Belgrade, Serbia. Consultant neurologist at the Department for immune-mediated CNS disorders, Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia. Main field of research interest is diagnosis and treatment of MS and related disorders and neuroimaging.

Vice-president of Serbian Neuroimmunology Society.  

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