medwireNews: The presence of cortical lesions (CL) and the central vein sign (CVS) on magnetic resonance imaging (MRI) shows high specificity for distinguishing multiple sclerosis from other conditions associated with brain lesions, shows a study published in JAMA Neurology.
Cristina Granziera (University Hospital Basel, Switzerland) and colleagues explain that “the role of the CVS and CLs in clinical practice is limited,” which they say is due to “insufficient evidence for a real advantage of these imaging biomarkers as compared to currently available ones and by the lack of widespread technology availability.”
They analyzed MRI and clinical data collected between 2010 and 2020 from 14 European academic centers within the Magnetic Resonance Imaging in MS framework, as well as the multicenter European Prevention of Alzheimer’s Dementia cohort.
The 1051 study participants were over 18 years old and had T-2 hyperintense white matter lesions (WMLs), and a brain 3-T scan with at least one sequence suitable for CL and CVS assessment. Of these, 599 had a diagnosis of MS or clinically isolated syndrome (CIS, 64.4% women, mean age 41.5 years), and 452 had non-MS conditions (66.8% women, mean age 49.2 years), such as neuroinflammatory disorders, cerebrovascular disease, migraine, or incidental WMLs.
The researchers report a relatively high rate of CLs in patients with MS or CIS, at 59.9% and 49.0%, respectively, compared with rates of 1.1% to 24.1% among the other patients, and the CL count was significantly higher for these conditions than for each of the non-MS conditions.
The presence of CLs differentiated MS/CIS from other conditions with an accuracy of 77%, and a cutoff of one CL provided the “highest discriminative performance,” with 59.0% sensitivity, 93.6% specificity, and 73.9% accuracy.
Granziera and colleagues highlight that the CL detection rate was similar between 3-D-T1/MP2RAGE images (which were available for all patients) and both double inversion recovery and phase-sensitive inversion recovery images (available for 299 and 20 patients, respectively), which they say “might have practical implications since 3-D T1-weighted images are increasingly available in clinical practice.”
Analysis of over 12,000 WMLs from 934 study participants who had lesions suitable for CVS assessment, showed CVS-positive lesions were present in 62.1% of MS patients and 68.4% of CIS patients. This was double the highest rate among the non-MS conditions of 33% in patients with myelin oligodendrocyte glycoprotein antibody-associated disease.
The diagnostic performance of CVS for differentiating MS/CIS was superior to that of CLs, with an accuracy of 89%, and at a previously proposed threshold of 40% of positive CVS lesions MS/CIS was detected with a sensitivity, specificity, and accuracy of 78.7%, 86.0%, and 81.5%, respectively.
However, the best discriminative performance was seen using a 26% proportion of positive CVS lesions based on the Youden index, at a sensitivity, specificity, and accuracy of 88.0%, 80.9%, and 85.3%, respectively.
The combination of CLs and CVS offered a higher diagnostic performance than either biomarker alone, at an accuracy of 92%, and Granziera et al report that in a random forest model “these 2 biomarkers outperformed the presence of WMLs in brain locations characteristic of MS (infratentorial, periventricular, juxtacortical).”
They conclude that “CVS and CLs, as assessed on dedicated MRI sequences, may be valuable tools to optimize the accuracy of MS diagnosis.”
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