Contributions
Abstract: P815
Type: Poster Sessions
Abstract Category: Pathology and pathogenesis of MS - MRI and PET
Introduction: MS misdiagnosis is a frequent problem, especially when clinical, imaging, or laboratory features are not typical for MS. The central vein sign (CVS)2 has been shown to help in the differential diagnosis,3 but most prior studies are retrospective. Prospective,4 multicenter studies starting from the time of initial work-up are needed to assess the true diagnostic value of the CVS, especially in difficult cases.
Objective: To prospectively assess the diagnostic predictive value of the CVS on 3T FLAIR* images in diagnostically difficult cases.
Methods: Patients with suspected MS who had clinical, imaging, or laboratory “red flags” (i.e., features atypical for MS5) underwent a single-standardized 3T MRI protocol in Milan, Italy; Brussels, Belgium; or Lausanne, Switzerland.3 FLAIR* images were generated and blindly analyzed by two independent observers for the presence of the CVS.2 All patients received an extensive work-up, and expert clinicians, blinded to the results of the CVS assessment, came to a final diagnosis. The value of the percentage of CVS-positive lesions to prospectively predict MS diagnosis was assessed.
Results: All patients (n=17) had at least one clinical (n=8), imaging (n=1), or laboratory (n=8) red flag at initial presentation. After an extensive work-up, MS was confirmed in a total of 12 patients, 4 of whom were diagnosed as having MS and a concomitant systemic inflammatory disorder. Five patients received an alternative diagnosis (neuro-Sjögren, neuro-lupus, spondyloarthritis, SPG4-spastic-paraparesis, and migraine). The percentage of perivenular lesions was >50% in all patients with final diagnosis of MS but < 50% in non-MS patients (n=5). Agreement between raters was 94% (16/17 cases).
Conclusions: Our data provide preliminary evidence that the CVS detected on 3T FLAIR* images can accurately predict MS diagnosis in patients suspected to have MS, but with atypical clinical, laboratory, and imaging features.
References:
1. Solomon AJ, et al., Nat Rev Neurol 2017; 13:567- 572.
2. Sati P, et al., Nat Rev Neurol 2016; 12:714-722.
3. Maggi P, Absinta M, et al., Ann Neurol 2018; 83:283-294.
4. Mistry N, et al. JAMA Neurol 2013; 70:623-628.
5. Geraldes R, et al., Nat Rev Neurol 2018; 14:199-213.
Disclosure: P. Maggi is supported by the ECTRIMS Clinical Training Fellowship Program.
M. Absinta has nothing to disclose
P. Sati has nothing to disclose
G. Perrotta has nothing to disclose
B. Dachy has nothing to disclose
C. Pot has nothing to disclose
R. Meuli has nothing to disclose
DS. Reich has nothing to disclose
M. Filippi has nothing to disclose
R. Du Pasquier has nothing to disclose
M. Theaudin has nothing to disclose
Abstract: P815
Type: Poster Sessions
Abstract Category: Pathology and pathogenesis of MS - MRI and PET
Introduction: MS misdiagnosis is a frequent problem, especially when clinical, imaging, or laboratory features are not typical for MS. The central vein sign (CVS)2 has been shown to help in the differential diagnosis,3 but most prior studies are retrospective. Prospective,4 multicenter studies starting from the time of initial work-up are needed to assess the true diagnostic value of the CVS, especially in difficult cases.
Objective: To prospectively assess the diagnostic predictive value of the CVS on 3T FLAIR* images in diagnostically difficult cases.
Methods: Patients with suspected MS who had clinical, imaging, or laboratory “red flags” (i.e., features atypical for MS5) underwent a single-standardized 3T MRI protocol in Milan, Italy; Brussels, Belgium; or Lausanne, Switzerland.3 FLAIR* images were generated and blindly analyzed by two independent observers for the presence of the CVS.2 All patients received an extensive work-up, and expert clinicians, blinded to the results of the CVS assessment, came to a final diagnosis. The value of the percentage of CVS-positive lesions to prospectively predict MS diagnosis was assessed.
Results: All patients (n=17) had at least one clinical (n=8), imaging (n=1), or laboratory (n=8) red flag at initial presentation. After an extensive work-up, MS was confirmed in a total of 12 patients, 4 of whom were diagnosed as having MS and a concomitant systemic inflammatory disorder. Five patients received an alternative diagnosis (neuro-Sjögren, neuro-lupus, spondyloarthritis, SPG4-spastic-paraparesis, and migraine). The percentage of perivenular lesions was >50% in all patients with final diagnosis of MS but < 50% in non-MS patients (n=5). Agreement between raters was 94% (16/17 cases).
Conclusions: Our data provide preliminary evidence that the CVS detected on 3T FLAIR* images can accurately predict MS diagnosis in patients suspected to have MS, but with atypical clinical, laboratory, and imaging features.
References:
1. Solomon AJ, et al., Nat Rev Neurol 2017; 13:567- 572.
2. Sati P, et al., Nat Rev Neurol 2016; 12:714-722.
3. Maggi P, Absinta M, et al., Ann Neurol 2018; 83:283-294.
4. Mistry N, et al. JAMA Neurol 2013; 70:623-628.
5. Geraldes R, et al., Nat Rev Neurol 2018; 14:199-213.
Disclosure: P. Maggi is supported by the ECTRIMS Clinical Training Fellowship Program.
M. Absinta has nothing to disclose
P. Sati has nothing to disclose
G. Perrotta has nothing to disclose
B. Dachy has nothing to disclose
C. Pot has nothing to disclose
R. Meuli has nothing to disclose
DS. Reich has nothing to disclose
M. Filippi has nothing to disclose
R. Du Pasquier has nothing to disclose
M. Theaudin has nothing to disclose