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P0648 - The central vein sign as a biomarker for MS in the infratentorial brain (ID 920)

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The central vein sign (CVS) is a novel imaging biomarker for the differential diagnosis of multiple sclerosis (MS). In studies at 7.0 tesla MRI, the percentage of supratentorial white matter lesions (WMLs) with CVS vary between 80% to 100% in MS patient brains. Similar results were reported at 3.0 tesla (3T) MRI in optimized sequences, such as T2*-weighted 3D echo-planar-imaging sequence and SWAN-venule. The value of the CVS for infratentorial brain remains unknown.


The aim of this study was to determine the proportion of WMLs positive for the CVS in the brainstem and cerebellum of MS patients.


We included subjects with clinically defined MS, that showed at least one infratentorial lesion larger than 3 mm in 3D-FLAIR. Patients were scanned in a 3T MRI system (GE Medical Systems, discovery MR750) using a 32-channel coil array. MRI included 3D T2-weighted FLAIR and post-contrast SWAN-venule: [FOV = 22 cm x 16 cm; number of slices= 126; voxel resolution, 0.4 mm x 0.4 mm x 0.8 mm; TR = 47 msec; TE = 28 msec; flip angle (FA) = 8 degrees; ETL = 9; AT = 7.38 min]. The CVS, defined as a thin hypointense line or a hypointense small dot visualized in two planes, was recorded on SWAN-venule by two trained raters.


Thirty MRIs were analyzed, three were excluded for motion artefacts. A total of 91 focal lesions were detected in FLAIR, 22 in the cerebellum and 69 in brainstem. Out of 91 lesions, 83 (91%) were visible in SWAN-venule and 83% were positive for the CVS.


The infratentorial brain is a cardinal compartment for MS diagnosis, SWAN-venule detects infratentorial WMLs and highlights the CVS in most plaques at 3.0 T MRI. The CVS could be used to discriminate MS lesions from its radiological infratentorial mimics.