A multicenter pilot study evaluating simplified central vein assessment for the diagnosis of multiple sclerosis
Lynn Daboul, Carly M. O’Donnell, Moein Amin, Paulo Rodrigues, J. Andrew Derbyshire, Christina Azevedo, Amit Bar‐Or, Eduardo Caverzasi, Peter A. Calabresi, Bruce Cree, Léorah Freeman, Roland G. Henry, Erin E. Longbrake, Jiwon Oh, Nico Papinutto, Daniel Pelletier, Vesna Prchkovska, Praneeta Raza, Marc Ramos, Rohini Samudralwar, Matthew K. Schindler, Elias S. Sotirchos, Nancy L. Sicotte, Andrew Solomon, Russell T. Shinohara, Daniel S. Reich, Pascal Sati, Daniel Ontaneda
Abstract
BACKGROUND: The central vein sign (CVS) is a proposed magnetic resonance imaging (MRI) biomarker for multiple sclerosis (MS); the optimal method for abbreviated CVS scoring is not yet established. OBJECTIVE: The aim of this study was to evaluate the performance of a simplified approach to CVS assessment in a multicenter study of patients being evaluated for suspected MS. METHODS: Adults referred for possible MS to 10 sites were recruited. A post-Gd 3D T2*-weighted MRI sequence (FLAIR*) was obtained in each subject. Trained raters at each site identified up to six CVS-positive lesions per FLAIR* scan. Diagnostic performance of CVS was evaluated for a diagnosis of MS which had been confirmed using the 2017 McDonald criteria at thresholds including three positive lesions (Select-3*) and six positive lesions (Select-6*). Inter-rater reliability assessments were performed. RESULTS: = 55, 71%). The area under the receiver operating characteristic curve (AUROC) for the simplified counting method was 0.83 (95% CI: 0.73-0.93). Select-3* and Select-6* had sensitivity of 81% and 65% and specificity of 68% and 98%, respectively. Inter-rater agreement was 78% for Select-3* and 83% for Select-6*. CONCLUSION: A simplified method for CVS assessment in patients referred for suspected MS demonstrated good diagnostic performance and inter-rater agreement.