Author Of 2 Presentations
P0135 - Preventing multiple sclerosis misdiagnosis using the “central vein sign”: A real-world study (ID 500)
Abstract
Background
Misdiagnosis of multiple sclerosis (MS) is common and often occurs due to misattribution of non-MS magnetic resonance imaging (MRI) lesions to MS demyelination. A recently developed MRI biomarker, the central vein sign (CVS), has demonstrated high specificity for MS lesions and may thus help prevent misdiagnosis.
Objectives
We explored the potential “real world” value of CVS in preventing MS misdiagnosis by comparing CVS in patients with MS and patients previously misdiagnosed with MS by standard clinical practice and established diagnostic tools.
Methods
30 patients (15 with MS and 15 misdiagnosed with MS) were prospectively recruited to undergo 3T brain MRI. T2-weighted fluid-attenuated inversion recovery (FLAIR) and T2*-weighted segmented echo-planar-imaging (T2*-EPI) were acquired to generate FLAIR* images, then analyzed by two independent raters blinded to clinical information. The percentage of lesions with CVS was calculated for each patient.
Results
The number of brain lesions per patient did not significantly differ between the two groups. The number of lesions with CVS, however, did differ, with a mean of 0.93 lesions (range 0-6) in the misdiagnosed group versus 6.3 (range 0-15) in the MS group. A CVS lesion threshold of 29% or higher resulted in high adjusted sensitivity of 0.79 (95% CI: 0.68-0.95) and specificity of 0.88 (95% CI: 0.68-0.95) for MS and correctly identified 87% of patients previously misdiagnosed with MS. Interrater reliability for CVS was excellent with a Cohen’s kappa coefficient of 0.86.
Conclusions
Our study found that CVS differentiated with high sensitivity and specificity patients with MS from patients who were previously misdiagnosed with MS after undergoing routine clinical evaluation. We believe that our findings further support the incorporation of CVS in the diagnostic approach to MS to increase accuracy and reduce misdiagnosis.
P0542 - Assessment of central vein sign conspicuity in multicenter 3T FLAIR* imaging (ID 985)
- Q. Cao
- M. Martin
- B. Renner
- L. Daboul
- C. O'Donnell
- D. Moreno-Dominguez
- P. Rodrigues
- J. Derbyshire
- C. Azevedo
- A. Bar-Or
- E. Caverzasi
- P. Calabresi
- B. Cree
- L. Freeman
- R. Henry
- E. Longbrake
- J. Oh
- N. Papinutto
- R. Samudralwar
- M. Schindler
- E. Sotirchos
- N. Sicotte
- A. Solomon
- R. Shinohara
- D. Reich
- D. Ontaneda
- P. Sati
Abstract
Background
The central vein sign (CVS) is a proposed diagnostic biomarker for MS that can be identified using FLAIR*. The robustness of 3T FLAIR*, with and without the injection of gadolinium contrast agent (Gd), for imaging the CVS in a multicenter setting has not yet been demonstrated.
Objectives
To assess the conspicuity of the CVS on 3T FLAIR* imaging acquired across different sites with and without the injection of Gd.
Methods
A cross-sectional multicenter study recruited adults with a clinical and/or radiological suspicion of having MS from 10 sites within the North American Imaging in MS (NAIMS) Cooperative. High-isotropic-resolution T2*-weighted segmented echo-planar imaging (T2*-EPI) was acquired at 3T, pre- and post-injection of Gd, along with 3D FLAIR on different scanner brands and models. T2*-EPI and FLAIR images were processed on an online imaging platform (QMENTA) to generate FLAIR* images. To objectively assess the conspicuity of the CVS inside MS lesions, lesions and veins were segmented automatically and used to compute lesion-to-vein contrast-to-noise ratio (CNR) measures. ANOVA was used to compare CNR values across sites with post-hoc Tukey Honest Significant Difference testing. Multiple testing between sites was considered by controlling the false discovery rate. One-sided paired t-testing was used to compare the overall lesion-to-vein CNR values between pre- and post-Gd FLAIR*.
Results
Seventy-eight patients from nine sites were included in the analysis; one site was excluded due to low enrollment. The overall mean(coefficient of variation, CV) lesion-to-vein CNR values across the nine sites were 0.35(14%) and 0.37(12%) for pre- and post-Gd FLAIR*, respectively. Excluding an additional site that used an unharmonized FLAIR acquisition, the resulting mean(CV) CNR values were 0.36(12%) for pre-Gd and 0.37(11%) for post-Gd FLAIR*. Across most sites, there was a significant improvement in lesion-to-vein CNR measures for post-Gd compared to pre-Gd FLAIR* [mean difference = 0.011, p < 0.001, 95% CI: (0.008,0.015)].
Conclusions
Lesion-to-vein CNR measures across sites are in line with values first published for 3T FLAIR* and demonstrate the robustness of 3T FLAIR* for imaging the CVS in a multicenter setting. Moreover, there was an increase in vein conspicuity with improvement in CNR on post-Gd FLAIR*. Based on these results, a prospective multicenter NAIMS CVS diagnostic study, sponsored by NINDS, will use 3T FLAIR* imaging with Gd in the study protocol.