Šarlota Mesaroš : Central Vein Sign – A Highly Specific MRI Biomarker for Multiple Sclerosis

In this short video interview, Šarlota Mesaroš discusses the role of the central vein sign as an advanced MRI biomarker in multiple sclerosis.

While conventional MRI remains central to MS diagnosis, susceptibility-based imaging sequences now allow clinicians to visualize the venous origin of MS lesions. Šarlota highlights how the central vein sign, incorporated into the 2024 McDonald criteria, can support diagnosis and help distinguish MS from mimicking conditions, particularly when diagnostic uncertainty remains.

Watch the interview

What is the central vein sign, and why is it important in the diagnosis of multiple sclerosis?

In the interview, Šarlota Mesaroš explains the clinical value of the central vein sign as a highly specific and sensitive MRI biomarker in multiple sclerosis, particularly in the context of the latest revision of the McDonald criteria.

Key points discussed include:

• The central vein sign as a biomarker now incorporated into the 2024 McDonald criteria
• Why it improves diagnostic confidence when distinguishing MS from mimics
• The biological rationale behind lesions forming around small veins
• How modern MRI techniques enable its detection in clinical practice
• In which scenarios it may substitute traditional diagnostic requirements
• Why it is particularly valuable in diagnostically uncertain cases

How can radiologists and neurologists best use the central vein sign in everyday diagnostic work?

* Please note that all the captions were generated automatically. If they do not appear, click on CC in the navigation.

Key messages from Šarlota Mesaroš

The central vein sign represents a highly specific MRI biomarker that reflects the underlying pathobiology of multiple sclerosis. In the interview, Šarlota Mesaroš explains that MS lesions often develop around small veins, a feature that has become visible only with the development of susceptibility-based MRI sequences.

Integrated into the 2024 McDonald criteria, the central vein sign can support diagnosis by replacing dissemination in time or one topographic location in selected patients. Its value is particularly evident in cases where the distinction between MS and MS mimics is uncertain.

Overall, the interview highlights a precision-driven diagnostic approach: advanced MRI biomarkers like the central vein sign should be used strategically, complementing clinical assessment and standard imaging to strengthen diagnostic confidence without overreliance on any single marker.

Curious to learn more about the expert behind this interview?

Visit Šarlota Mesaroš’s full biography for more insights into her expertise.

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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