title: "Central vessel sign" on 3T FLAIR* MRI for the differentiation of multiple sclerosis from migraine.
abstract: OBJECTIVE
  The diagnosis of multiple sclerosis (MS) presently relies on radiographic assessments of imperfect specificity. Recent data using T2* methodology for the detection of the "central vessel sign" (CVS) in MS lesions suggests this novel MRI technique may distinguish MS from other disorders. Our aim was to determine if evaluation for CVS on 3T FLAIR* MRI differentiates MS from migraine.
  
  
  METHODS
  Patients with MS or migraine and a prior brain MRI demonstrating at least two hyperintense lesions ≥3 mm were recruited. Exclusion criteria included any additional comorbidity known to cause brain MRI abnormalities. 3T MRI was performed in each participant with administration of gadopentetate dimeglumine, and FLAIR* images were generated in postprocessing. The total number of discrete ovoid lesions ≥3 mm were counted on FLAIR, per participant, and subsequently evaluated for presence of CVS on FLAIR*. An exploratory method evaluating for CVS in a maximum of 12 lesions per subject was also completed.
  
  
  RESULTS
  Ten participants with MS and 10 with migraine completed the study. The median percentage (quartiles) of lesions in MS participants with CVS was 84 (79, 94) compared to 22 (15, 54) in migraine (P = 0.008). In a subanalysis by brain region, in the subcortical and deep white matter, the median percentage (quartiles) of lesions in MS participants with CVS was 88 (81, 100) compared to 19 (11, 54) in migraine (P = 0.004). This difference was not identified in juxtacortical, periventricular, or infratentorial regions.
  
  
  CONCLUSIONS
  Identification of CVS using FLAIR* on 3T MRI helps differentiate MS from migraine, particularly in the subcortical and deep white matter.
authors.affiliation: Department of Neurological Sciences University of Vermont College of Medicine Burlington Vermont.
authors.forename: Andrew J
authors.identifier: 0000-0003-1602-1554
authors.initials: AJ
authors.lastname: Solomon
authors.affiliation: Translational Neuroradiology Unit Division of Neuroimmunology and Neurovirology National Institute of Neurological Disorders and Stroke Bethesda Maryland.
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Schindler
authors.affiliation: Vermont Center for Clinical and Translational Science Burlington Vermont.
authors.forename: Diantha B
authors.initials: DB
authors.lastname: Howard
authors.affiliation: Department of Radiology University of Vermont College of Medicine Burlington Vermont.
authors.forename: Richard
authors.initials: R
authors.lastname: Watts
authors.affiliation: Translational Neuroradiology Unit Division of Neuroimmunology and Neurovirology National Institute of Neurological Disorders and Stroke Bethesda Maryland.
authors.forename: Pascal
authors.initials: P
authors.lastname: Sati
authors.affiliation: Department of Radiology University of Vermont College of Medicine Burlington Vermont.
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Nickerson
authors.affiliation: Translational Neuroradiology Unit Division of Neuroimmunology and Neurovirology National Institute of Neurological Disorders and Stroke Bethesda Maryland.
authors.forename: Daniel S
authors.identifier: 0000-0002-2628-4334
authors.initials: DS
authors.lastname: Reich