16. Diagnostic Utility of the Central Vein Sign in Multiple Sclerosis with Implementation of the 6 Lesion Rule

The central vein sign (CVS) is a radiological biomarker proposed as a differentiating tool between multiple sclerosis (MS) and nonspecific white matter diseases (WMD). In this case-control study, investigators, blinded to patients' clinical and demographic data, reviewed the brain MRI scans of 598 consecutive patients between January 2016 and August 2022 for the occurrence of the CVS. A total of 422 participants were included after excluding 176 patients. In total, 5939 brain lesions were analyzed: 4773 in 245 patients with MS and 1166 in 177 patients with other WMDs. In patients with MS, the CVS was detected in 1300 lesions (27.23%). The specificity of the 3- and 6-CVS lesion criteria was 89.8% and 100%, respectively. In the multivariate regression model, hypertension and optic neuritis onset were independently and negatively associated with the CVS. This study found the CVS to be highly specific in differentiating MS from other WMDs, and its integration into the MS diagnostic criteria could support MS diagnosis and improve patient outcomes.