Contributions
Abstract: P650
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Diagnosis and differential diagnosis
Introduction: There is no single test for multiple sclerosis (MS). While current diagnostic criteria work well in patients with a typical presentation, atypical white matter lesions (WMLs) on MRI or unusual clinical presentations can cause diagnostic uncertainty in MS clinics. The 'central vein sign' (CVS) has been proposed as an MRI marker that could help differentiate between MS and other WM pathologies. Here we present the first prospective, investigator blinded study to evaluate the diagnostic value of the CVS as compared to the eventual clinical diagnoses in patients with diagnostic uncertainty at presentation.
Aims: To test the usefulness of the CVS in diagnosing MS using a single 3T T2* scan.
Objectives: To calculate the proportion of WMLs with CVs for each patient and classify them as MS if more than 40% of lesions have CVs. To calculate the sensitivity, specificity and positive and negative predictive values (PPV and NPV) of the CVS in diagnosing MS in patients with atypical presentation.
Methods: Patients with possible MS, brain WMLs, and discrepant neuroradiological reports were recruited from the Nottingham MS Clinic and had 3D T2* with high EPI MRI. Two blinded raters estimated the proportion of WMLs with CVs and proposed a diagnosis of MS or non-MS.Results were then compared to the diagnoses given by the patients' neurologist after clinical follow-up and further tests including oligoclonal bands (OBs).
Results: 38 patients were recruited, 24 of whom had already been given a clinical diagnosis. Raters 1&2 identified 765 & 711 WMLs, respectively. The proportion of WMLs with CVs was 0.76 for MS and 0.26 for non-MS as calculated by Rater1 and 0.84 for MS and 0.26 for non-MS for Rater2. Rater 1's agreement with the clinical diagnoses was 83.2% with 100% sensitivity, 73.3% specificity, PPV=69.2% and NPV=100%. Rater2 achieved 79.2% agreement, with 88.9% sensitivity, 73.3% specificity, PPV= 66.7% and NPV=91.7%.
Conclusions: This prospective study demonstrates that the CVS, assessed using a single 3T scan, is diagnostically useful in patients with diagnostic uncertainty and complements previous studies in established MS. In this diagnostically challenging group the CVS appears to be broadly as useful as OBs with similar sensitivity and specificity values to those of OBs cited in literature. Since a diagnosis of MS often leads to demanding disease modifying therapies, it is vital that neurologists use all the information available to ensure a correct diagnosis.
Disclosure: M. Clarke: Nothing to disclose; A. Samaraweera: Nothing to disclose; Y. Falah: Nothing to disclose; A. Pitiot: Nothing to disclose; R. Dineen: Nothing to disclose; P. Morgan: Nothing to disclose; C. Tench: Nothing to disclose; N. Evangelou: has received funding and support from PCORI, MS Society, Biogen, Novartis, Roche and Teva
Abstract: P650
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Diagnosis and differential diagnosis
Introduction: There is no single test for multiple sclerosis (MS). While current diagnostic criteria work well in patients with a typical presentation, atypical white matter lesions (WMLs) on MRI or unusual clinical presentations can cause diagnostic uncertainty in MS clinics. The 'central vein sign' (CVS) has been proposed as an MRI marker that could help differentiate between MS and other WM pathologies. Here we present the first prospective, investigator blinded study to evaluate the diagnostic value of the CVS as compared to the eventual clinical diagnoses in patients with diagnostic uncertainty at presentation.
Aims: To test the usefulness of the CVS in diagnosing MS using a single 3T T2* scan.
Objectives: To calculate the proportion of WMLs with CVs for each patient and classify them as MS if more than 40% of lesions have CVs. To calculate the sensitivity, specificity and positive and negative predictive values (PPV and NPV) of the CVS in diagnosing MS in patients with atypical presentation.
Methods: Patients with possible MS, brain WMLs, and discrepant neuroradiological reports were recruited from the Nottingham MS Clinic and had 3D T2* with high EPI MRI. Two blinded raters estimated the proportion of WMLs with CVs and proposed a diagnosis of MS or non-MS.Results were then compared to the diagnoses given by the patients' neurologist after clinical follow-up and further tests including oligoclonal bands (OBs).
Results: 38 patients were recruited, 24 of whom had already been given a clinical diagnosis. Raters 1&2 identified 765 & 711 WMLs, respectively. The proportion of WMLs with CVs was 0.76 for MS and 0.26 for non-MS as calculated by Rater1 and 0.84 for MS and 0.26 for non-MS for Rater2. Rater 1's agreement with the clinical diagnoses was 83.2% with 100% sensitivity, 73.3% specificity, PPV=69.2% and NPV=100%. Rater2 achieved 79.2% agreement, with 88.9% sensitivity, 73.3% specificity, PPV= 66.7% and NPV=91.7%.
Conclusions: This prospective study demonstrates that the CVS, assessed using a single 3T scan, is diagnostically useful in patients with diagnostic uncertainty and complements previous studies in established MS. In this diagnostically challenging group the CVS appears to be broadly as useful as OBs with similar sensitivity and specificity values to those of OBs cited in literature. Since a diagnosis of MS often leads to demanding disease modifying therapies, it is vital that neurologists use all the information available to ensure a correct diagnosis.
Disclosure: M. Clarke: Nothing to disclose; A. Samaraweera: Nothing to disclose; Y. Falah: Nothing to disclose; A. Pitiot: Nothing to disclose; R. Dineen: Nothing to disclose; P. Morgan: Nothing to disclose; C. Tench: Nothing to disclose; N. Evangelou: has received funding and support from PCORI, MS Society, Biogen, Novartis, Roche and Teva