title: Central veins in brain lesions visualized with high-field magnetic resonance imaging: a pathologically specific diagnostic biomarker for inflammatory demyelination in the brain.
abstract: OBJECTIVE
  There is no single test that is diagnostic for multiple sclerosis (MS), and existing diagnostic criteria are imperfect. This can lead to diagnostic delay. Some patients require multiple (sometimes invasive) investigations, and extensive clinical follow-up to confirm or exclude a diagnosis of MS. A diagnostic biomarker that is pathologically specific for the inflammatory demyelination in MS could overhaul current diagnostic algorithms.
  
  
  OBJECTIVE
  To prospectively assess the diagnostic value of visualizing central veins in brain lesions with magnetic resonance imaging (MRI) for patients with possible MS for whom the diagnosis is uncertain.
  
  
  METHODS
  Prospective longitudinal cohort study. The reference standard is a clinical diagnosis that is arrived at (after a mean follow-up of 26 months) by the treating neurologist with a specialist interest in MS. The 7-T MRI scans were analyzed at baseline, by physicians blinded to the clinical data, for the presence of visible central veins.
  
  
  METHODS
  Academic MS referral center.
  
  
  METHODS
  A consecutive sample of 29 patients referred with possible MS who had brain lesions detected on clinical MRI scans but whose condition remained undiagnosed despite expert clinical and radiological assessments.
  
  
  METHODS
  Seven-Tesla MRI using a T2*-weighted sequence.
  
  
  METHODS
  The proportion of patients whose condition was correctly diagnosed as MS or as not MS, using 7-T MRI at study onset, compared with the eventual diagnosis reached by treating physicians blinded to the result of the MRI scan.
  
  
  RESULTS
  Of the 29 patients enrolled and scanned using 7-T MRI, so far 22 have received a clinical diagnosis. All 13 patients whose condition was eventually diagnosed as MS had central veins visible in the majority of brain lesions at baseline. All 9 patients whose condition was eventually not diagnosed as MS had central veins visible in a minority of lesions.
  
  
  CONCLUSIONS
  In our study, T2*-weighted 7-T MRI had 100% positive and negative predictive value for the diagnosis of MS. Clinical application of this technique could improve existing diagnostic algorithms.
authors.affiliation: Division of Clinical Neurology, Queen's Medical Centre, University of Nottingham, England.
authors.forename: Niraj
authors.initials: N
authors.lastname: Mistry
authors.forename: Jennifer
authors.initials: J
authors.lastname: Dixon
authors.forename: Emma
authors.initials: E
authors.lastname: Tallantyre
authors.forename: Christopher
authors.initials: C
authors.lastname: Tench
authors.forename: Rasha
authors.initials: R
authors.lastname: Abdel-Fahim
authors.forename: Tim
authors.initials: T
authors.lastname: Jaspan
authors.forename: Paul S
authors.initials: PS
authors.lastname: Morgan
authors.forename: Peter
authors.initials: P
authors.lastname: Morris
authors.forename: Nikos
authors.initials: N
authors.lastname: Evangelou
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers; D001921:Brain / Q000098:blood supply* / Q000473:pathology* / Q000503:physiopathology; D002550:Cerebral Veins / Q000473:pathology*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000473:pathology* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016037:Single-Blind Method; D013997:Time Factors
chemical_list: D015415:Biomarkers