Washington University
Neurology

Author Of 2 Presentations

Imaging Poster Presentation

P0581 - Gradient echo magnetic resonance imaging to detect central vein sign in patients with Multiple Sclerosis (ID 1528)

Speakers
Presentation Number
P0581
Presentation Topic
Imaging

Abstract

Background

Diagnostic criteria for multiple sclerosis (MS) have undergone several iterations in the past 20 years, resulting in increased sensitivity and earlier diagnosis, but also increased misdiagnoses due to reduced specificity. Biomarkers are needed to distinguish MS from its mimics and between MS subtypes. MS lesions in white matter (WM) typically form around a central vein, which can be visualized with FLAIR* imaging (Sati, et al, 2012). Central vein sign (CVS) presence on MRI can help differentiate MS from other diseases with WM T2-weighted hyperintensities and may increase the sensitivity and specificity of MS diagnosis.

Objectives

To apply MRI-based gradient echo plural contrast imaging (GEPCI) approach (Luo, et al, 2012) to generate FLAIR*-like images and detect CVS in patients with progressive MS (PMS) and relapsing remitting MS (RRMS). To quantitatively evaluate tissue damage in lesions with and without CVS using tissue-specific GEPCI R2t* metric (Xiang, et al, 2019).

Methods

MRI scans of PMS (n=39) and RRMS subjects (n=30) were analyzed for the CVS within WM lesions. Presence of CVS, lesion volume, and anatomic location were determined. To quantitatively evaluate the severity of brain-tissue damage in MS lesions, mean R2t* was calculated. R2t* is a quantitative measure that correlates with brain tissue cellular density and is decreased in areas of reduced tissue integrity. The proportion of total lesions with CVS was calculated, excluding confluent lesions and lesions with more than 1 central vein. Median proportions in PMS and RRMS subjects were compared using the Wilcoxon sign rank test. Individual lesion CVS status was examined using generalized linear models. Linear mixed models adjusted for age were used to evaluate predictors of mean R2t* in nonconfluent lesions with only one central vein of sufficient size. Associations of CVS and clinical data from time of MRI scan, including Expanded Disability Status Scale (EDSS), symbol digit modality test (SDMT), and multiple sclerosis functional composite (MSFC) were made using Spearman correlations.

Results

The PMS group had significantly higher EDSS scores and poorer performance on SDMT and MSFC than the RRMS group. There were no significant differences in total CVS and percentage of CVS per lesion between MS subtypes. Controlling for age, EDSS, and lesion volume did not increase the odds of either group having CVS. Lesions with CVS had lower R2t* (greater tissue damage). However, accounting for MS type, age, and lesion count reduced significance (p = 0.09). Mean R2t* was significantly lower in PMS than RRMS (p = 0.027) and declined with age (p = 0.023).

Conclusions

This study did not find that the presence of CVS could distinguish between patients with RRMS and PMS. Our data suggest that lesions with CVS have more tissue damage. Due to reduced significance after accounting for additional variables, further studies with more patients are needed.

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Pediatric MS Poster Presentation

P1071 - Central Vein Sign in Pediatric Multiple Sclerosis and MOG Antibody Associated Disease. (ID 859)

Speakers
Presentation Number
P1071
Presentation Topic
Pediatric MS

Abstract

Background

Multiple sclerosis (MS) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are demyelinating conditions of the central nervous system that have been difficult to distinguish based on clinical presentation or MRI findings. MOG-IgG titers are used to help differentiate between MS and MOGAD currently, but has been unreliable as MOG-IgG titers fluctuate, titer thresholds are not yet clear, and titers can become undetectable between relapses. MOGAD is detected in up to 30% of children with acute demyelination and treatment options and prognosis are different for MOGAD and MS. Thus, early and accurate diagnosis is essential. The central vein sign (CVS) on brain magnetic resonance imaging (MRI) is now a promising marker for adult MS and can differentiate MS from its mimics. The presence of this marker is not well established in pediatric patients.

Objectives

We aimed to evaluate the rate of CVS within demyelinating lesions of the brain in children with MS and MOGAD and determine its diagnostic value in distinguishing these diseases.

Methods

Patients with a diagnosis of pediatric onset MS (POMS) or MOGAD at last follow-up were identified in a pediatric demyelinating database at St. Louis Children’s Hospital, which was maintained for the US Network of Pediatric MS Centers. Two reviewers, blinded to the clinical diagnosis, retrospectively reviewed clinically obtained brain MRIs in each of these patients. Fluid attenuated inversion recovery (FLAIR) sequences were used to identify lesions. Susceptibility weighted imaging (SWI) fused to the FLAIR sequences were used to assess the prevalence of CVS. Differences in CVS between POMS and MOGAD were evaluated, and agreement in CVS number was reported using an intraclass correlation coefficient (ICC).

Results

A total of 20 pediatric patients, 10 with POMS and 10 MOGAD, were assessed. Mean (SD) age was 11.6(4.7) years in POMS and 7.1(3.3) years in MOGAD. 60% in POMS and 70% in MOGAD were female. The CVS was significantly more prevalent in POMS when compared to MOGAD, 53% of total lesions compared to 19%, respectively (p<0.001). Inter-rater reliability for identifying the total number of white matter lesions was good (ICC 0.88 [95%CI: 0.723, 0.950]). However, the inter-rater reliability for detecting the number of CVS lesions was poor (ICC 0.23 [95%CI: 0.221, 0.598]).

Conclusions

The CVS can be a useful diagnostic tool to help differentiate MS from MOGAD in pediatric patients, but poor inter-rater reliability using current clinical brain MRIs may limit the usefulness of CVS in individual cases. Application of CVS to individual cases of MS versus MOGAD could be improved with an MRI sequence optimized for detection of CVS, as well as a validated automated assessment to diminish the effects of variability between reviewers.

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Presenter Of 1 Presentation

Imaging Poster Presentation

P0581 - Gradient echo magnetic resonance imaging to detect central vein sign in patients with Multiple Sclerosis (ID 1528)

Speakers
Presentation Number
P0581
Presentation Topic
Imaging

Abstract

Background

Diagnostic criteria for multiple sclerosis (MS) have undergone several iterations in the past 20 years, resulting in increased sensitivity and earlier diagnosis, but also increased misdiagnoses due to reduced specificity. Biomarkers are needed to distinguish MS from its mimics and between MS subtypes. MS lesions in white matter (WM) typically form around a central vein, which can be visualized with FLAIR* imaging (Sati, et al, 2012). Central vein sign (CVS) presence on MRI can help differentiate MS from other diseases with WM T2-weighted hyperintensities and may increase the sensitivity and specificity of MS diagnosis.

Objectives

To apply MRI-based gradient echo plural contrast imaging (GEPCI) approach (Luo, et al, 2012) to generate FLAIR*-like images and detect CVS in patients with progressive MS (PMS) and relapsing remitting MS (RRMS). To quantitatively evaluate tissue damage in lesions with and without CVS using tissue-specific GEPCI R2t* metric (Xiang, et al, 2019).

Methods

MRI scans of PMS (n=39) and RRMS subjects (n=30) were analyzed for the CVS within WM lesions. Presence of CVS, lesion volume, and anatomic location were determined. To quantitatively evaluate the severity of brain-tissue damage in MS lesions, mean R2t* was calculated. R2t* is a quantitative measure that correlates with brain tissue cellular density and is decreased in areas of reduced tissue integrity. The proportion of total lesions with CVS was calculated, excluding confluent lesions and lesions with more than 1 central vein. Median proportions in PMS and RRMS subjects were compared using the Wilcoxon sign rank test. Individual lesion CVS status was examined using generalized linear models. Linear mixed models adjusted for age were used to evaluate predictors of mean R2t* in nonconfluent lesions with only one central vein of sufficient size. Associations of CVS and clinical data from time of MRI scan, including Expanded Disability Status Scale (EDSS), symbol digit modality test (SDMT), and multiple sclerosis functional composite (MSFC) were made using Spearman correlations.

Results

The PMS group had significantly higher EDSS scores and poorer performance on SDMT and MSFC than the RRMS group. There were no significant differences in total CVS and percentage of CVS per lesion between MS subtypes. Controlling for age, EDSS, and lesion volume did not increase the odds of either group having CVS. Lesions with CVS had lower R2t* (greater tissue damage). However, accounting for MS type, age, and lesion count reduced significance (p = 0.09). Mean R2t* was significantly lower in PMS than RRMS (p = 0.027) and declined with age (p = 0.023).

Conclusions

This study did not find that the presence of CVS could distinguish between patients with RRMS and PMS. Our data suggest that lesions with CVS have more tissue damage. Due to reduced significance after accounting for additional variables, further studies with more patients are needed.

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