MRI characterization of the “central vein sign” in brain white matter lesions of patients with multiple sclerosis but possible “better explanation of the diagnosis” (P4.400)

Objective: To analyze the “central vein sign” (CVS) in multiple sclerosis (MS) patients at high risk of misdiagnosis as those with possible “better explanation”. Background: Misdiagnosis may occur in about 5–10% of MS cases, mainly because of unspecific MRI diagnostic criteria. However a pathological hallmark of MS as the perivenular location of the inflammatory-demyelinating lesions in brain white matter (BWM) can now be visualized by conventional MRI methods, allowing in vivo discrimination of MS lesions from lesions due to arteriolar chronic micro-angiopathy or to migraine (Mistry et al. 2015; Solomon et al. 2015). In addition the CVS can also discriminate BWM MS lesions from ischemic lesions due to inflammatory-autoimmune micro-angiopathies, often characterized by MS-like clinical courses (Vuolo L. et al. 2015). Analyisis of the CVS in definite MS and in MS at risk of misdiagnosis is herewith reported. Design/Methods: Inclusion criteria: Definite MS or MS with predefined clinical, serological and MRI criteria of possible “better explanation” of the diagnosis, but not fulfilling the diagnostic criteria of other diseases (Possible MS). Each patient received one brain MRI (1.5 T) including volumetric T2*-EPI and FLAIR sequences after gadolinium injection. White matter lesions were considered perivenular if an intralesional hypointense signal was completely surrounded by hyperintense signal in at least 2 perpendicular planes. Results: Forty-two patients (27 Definite and 15 Possible MS) thus far completed the analysis. Age, disease duration and disability was comparable between groups. The median frequency/patient of lesions with CVS was 89% (range= 68–100%) in the Definite MS group and 17.5% (range= 9–78%) in the Possible MS group. Categorizing the patients AS CVS positive or negative according to a CVS frequency ≥ 68%, all the Definite MS resulted positive, whereas 10/15 Possible MS resulted negative. (66%) Conclusions: Analysis of the CVS frequency can improve specificity of the current MRI criteria for the diagnosis of MS. Disclosure: Dr. Grammatico has nothing to disclose. Dr. Repice has received personal compensation for activities with Biogen Idec , Genzyme, Novartis, and Merck Serono as a speaker and advisory board member. Dr. Carlucci has nothing to disclose. Dr. Vuolo has nothing to disclose. Dr. Mechi has nothing to disclose. Dr. Barilaro has nothing to disclose. Dr. Fainardi has nothing to disclose. Dr. Massacesi has nothing to disclose.