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Al-Louzi O, Manukyan S, Donadieu M, Absinta M, Letchuman V, Calabresi B, Desai P, Beck ES, Roy S, Ohayon J, Pham DL, Thomas A, Jacobson S, Cortese I, Auluck PK, Nair G, Sati P, Reich DS. Lesion size and shape in central vein sign assessment for multiple sclerosis diagnosis: An in vivo and postmortem MRI study. Mult Scler 2022; 28:1891-1902. [PMID: 35674284 DOI: 10.1177/13524585221097560] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The "central vein sign" (CVS), a linear hypointensity on T2*-weighted imaging corresponding to a central vein/venule, is associated with multiple sclerosis (MS) lesions. The effect of lesion-size exclusion criteria on MS diagnostic accuracy has not been extensively studied. OBJECTIVE Investigate the optimal lesion-size exclusion criteria for CVS use in MS diagnosis. METHODS Cross-sectional study of 163 MS and 51 non-MS, and radiological/histopathological correlation of 5 MS and 1 control autopsy cases. The effects of lesion-size exclusion on MS diagnosis using the CVS, and intralesional vein detection on histopathology were evaluated. RESULTS CVS+ lesions were larger compared to CVS- lesions, with effect modification by MS diagnosis (mean difference +7.7 mm3, p = 0.004). CVS percentage-based criteria with no lesion-size exclusion showed the highest diagnostic accuracy in differentiating MS cases. However, a simple count of three or more CVS+ lesions greater than 3.5 mm is highly accurate and can be rapidly implemented (sensitivity 93%; specificity 88%). On magnetic resonance imaging (MRI)-histopathological correlation, the CVS had high specificity for identifying intralesional veins (0/7 false positives). CONCLUSION Lesion-size measures add important information when using CVS+ lesion counts for MS diagnosis. The CVS is a specific biomarker corresponding to intralesional veins on histopathology.
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Affiliation(s)
- Omar Al-Louzi
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA; Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sargis Manukyan
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA; Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Maxime Donadieu
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Martina Absinta
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD; USA/IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Vijay Letchuman
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Brent Calabresi
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Parth Desai
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Erin S Beck
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Snehashis Roy
- Section on Neural Function, National Institute of Mental Health, Bethesda, MD, USA
| | - Joan Ohayon
- Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Dzung L Pham
- Center for Neuroscience and Regenerative Medicine, The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Anish Thomas
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Steven Jacobson
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Irene Cortese
- Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Pavan K Auluck
- Human Brain Collection Core, National Institute of Mental Health, Bethesda, MD, USA
| | - Govind Nair
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Pascal Sati
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA; Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
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Carnero Contentti E, Marques VD, Soto de Castillo I, Tkachuk V, Barreira AA, Caride A, Castillo MC, Cristiano E, de Aquino Cruz C, Braga Diégues Serva G, Santos ACD, Labarca R, Lavigne Moreira C, López PA, Miguez J, Molina O, Pettinicchi JP, Rojas JI. Brain and spinal MRI features distinguishing MS from different AQP4 antibody serostatus NMOSD at disease onset in a cohort of Latin American patients. Mult Scler 2019; 26:945-954. [PMID: 31124748 DOI: 10.1177/1352458519849517] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We aimed to evaluate magnetic resonance imaging (MRI) previously used criteria (Matthews's criteria, MC) for differentiating multiple sclerosis (MS) from neuromyelitis optica spectrum disorders (NMOSD) in Caucasian and non-Caucasian populations (Argentina, Brazil and Venezuela) with positive (P-NMOSD), negative (N-NMOSD), and unknown (U-NMOSD) aquaporin-4 antibody serostatus at disease onset and to assess the added diagnostic value of spinal cord MRI in these populations. METHODS We reviewed medical records, and MRIs were assessed by two blinded evaluators and were scored using MC. Short-segment transverse myelitis (STM) was added as a new criterion. MC sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined. RESULTS We included 282 patients (MS = 188 and NMOSD = 94). MC applied to the entire cohort showed 97.8% sensitivity, 82.9% specificity, 92.0% PPV, and 95.1% NPV for differentiating MS from NMOSD. A subanalysis applied only to non-Caucasian (MS = 89 and NMOSD = 47) showed 100% sensitivity, 80.8% specificity, 90.8% PPV, and 100% NPV. Similar sensitivity, specificity, PPV, and NPV of MC for MS versus P-NMOSD (n = 55), N-NMOSD (n = 28), and U-NMOSD (n = 21) were observed. CONCLUSION MC distinguished MS from NMOSD of all serostatus in a Latin American cohort that included non-Caucasian populations. Addition of STM to MC did not raise the accuracy significantly.
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Affiliation(s)
| | - Vanessa Daccach Marques
- Department of Neurosciences and Behavioral Sciences, Hospital das Clínicas, Ribeirão Preto Medical School, University of de São Paulo, São Paulo, Brazil
| | | | - Verónica Tkachuk
- Neuroimmunology Unit, Department of Neurology, Hospital de Clínicas "José de San Martín," Buenos Aires, Argentina
| | - Amilton Antunes Barreira
- Department of Neurosciences and Behavioral Sciences, Hospital das Clínicas, Ribeirão Preto Medical School, University of de São Paulo, São Paulo, Brazil
| | - Alejandro Caride
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Maria C Castillo
- Neurology Department, Hospital Universitario de Maracaibo, Maracaibo, Venezuela
| | - Edgardo Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Camila de Aquino Cruz
- Department of Neurosciences and Behavioral Sciences, Hospital das Clínicas, Ribeirão Preto Medical School, University of de São Paulo, São Paulo, Brazil
| | - Gabriel Braga Diégues Serva
- Department of Neurosciences and Behavioral Sciences, Hospital das Clínicas, Ribeirão Preto Medical School, University of de São Paulo, São Paulo, Brazil
| | - Antonio Carlos Dos Santos
- Department of Neurosciences and Behavioral Sciences, Hospital das Clínicas, Ribeirão Preto Medical School, University of de São Paulo, São Paulo, Brazil
| | - Rossanny Labarca
- Neurology Department, Hospital Universitario de Maracaibo, Maracaibo, Venezuela
| | - Carolina Lavigne Moreira
- Department of Neurosciences and Behavioral Sciences, Hospital das Clínicas, Ribeirão Preto Medical School, University of de São Paulo, São Paulo, Brazil
| | - Pablo A López
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Jimena Miguez
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Omaira Molina
- Neurology Department, Hospital Universitario de Maracaibo, Maracaibo, Venezuela
| | - Juan Pablo Pettinicchi
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Ignacio Rojas
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Arrambide G, Tintore M, Auger C, Río J, Castilló J, Vidal-Jordana A, Galán I, Nos C, Comabella M, Mitjana R, Mulero P, de Barros A, Rodríguez-Acevedo B, Midaglia L, Sastre-Garriga J, Rovira A, Montalban X. Lesion topographies in multiple sclerosis diagnosis: A reappraisal. Neurology 2017; 89:2351-2356. [PMID: 29101276 PMCID: PMC5719929 DOI: 10.1212/wnl.0000000000004715] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 08/30/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To assess the contributions of cortico-juxtacortical and corpus callosum lesions to multiple sclerosis diagnosis and to compare the value of ≥1 vs ≥3 periventricular lesions in clinically isolated syndromes (CIS). METHODS Step 1: We evaluated lesion topography classifications in 657 patients with CIS with stepwise Cox proportional hazards regression models considering second attack as the outcome. Step 2: We established 2 dissemination in space (DIS) versions according to the periventricular lesion cutoffs of ≥1 and ≥3 and assessed their performance at 10 years with second attack as the outcome, first individually and then combined with dissemination in time (DIT) in all cases (n = 326), by age, and by CIS topography. RESULTS Step 1: The models (hazard ratios [95% confidence interval]) favored ≥1 over ≥3 periventricular lesions (2.5 [1.7-3.6]) and cortico-juxtacortical over juxtacortical lesions (1.4 [1.0-1.8]). Callosal lesions were not selected. Step 2: DIS specificity with ≥1 periventricular lesions was slightly lower than with ≥3 (59.1 vs 61.4) and the same after adding DIT (88.6). Regarding age, ≥3 periventricular lesions improved DIS specificity over ≥1 lesions in the 40-49 years of age bracket (66.7 vs 58.3). This difference disappeared when adding DIT (83.3). Optic neuritis had a similar pattern when evaluating CIS topographies. CONCLUSIONS Our results comply with the Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS) consensus recommendation of combining cortical and juxtacortical lesions into a single term when possible. Concerning periventricular lesions, maintaining the current ≥1 cutoff in the McDonald criteria does not compromise specificity in typical CIS cases, but attention should be paid to older patients or optic neuritis cases.
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Affiliation(s)
- Georgina Arrambide
- From Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (CEMCAT) (G.A., M.T., J.R., J.C., A.V.-J., I.G., C.N., M.C., P.M., B.R.-A., L.M., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (IDI) (C.A., R.M., A.d.B., A.R.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital, University of Toronto, Canada
| | - Mar Tintore
- From Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (CEMCAT) (G.A., M.T., J.R., J.C., A.V.-J., I.G., C.N., M.C., P.M., B.R.-A., L.M., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (IDI) (C.A., R.M., A.d.B., A.R.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital, University of Toronto, Canada
| | - Cristina Auger
- From Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (CEMCAT) (G.A., M.T., J.R., J.C., A.V.-J., I.G., C.N., M.C., P.M., B.R.-A., L.M., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (IDI) (C.A., R.M., A.d.B., A.R.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital, University of Toronto, Canada
| | - Jordi Río
- From Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (CEMCAT) (G.A., M.T., J.R., J.C., A.V.-J., I.G., C.N., M.C., P.M., B.R.-A., L.M., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (IDI) (C.A., R.M., A.d.B., A.R.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital, University of Toronto, Canada
| | - Joaquín Castilló
- From Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (CEMCAT) (G.A., M.T., J.R., J.C., A.V.-J., I.G., C.N., M.C., P.M., B.R.-A., L.M., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (IDI) (C.A., R.M., A.d.B., A.R.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital, University of Toronto, Canada
| | - Angela Vidal-Jordana
- From Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (CEMCAT) (G.A., M.T., J.R., J.C., A.V.-J., I.G., C.N., M.C., P.M., B.R.-A., L.M., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (IDI) (C.A., R.M., A.d.B., A.R.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital, University of Toronto, Canada
| | - Ingrid Galán
- From Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (CEMCAT) (G.A., M.T., J.R., J.C., A.V.-J., I.G., C.N., M.C., P.M., B.R.-A., L.M., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (IDI) (C.A., R.M., A.d.B., A.R.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital, University of Toronto, Canada
| | - Carlos Nos
- From Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (CEMCAT) (G.A., M.T., J.R., J.C., A.V.-J., I.G., C.N., M.C., P.M., B.R.-A., L.M., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (IDI) (C.A., R.M., A.d.B., A.R.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital, University of Toronto, Canada
| | - Manuel Comabella
- From Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (CEMCAT) (G.A., M.T., J.R., J.C., A.V.-J., I.G., C.N., M.C., P.M., B.R.-A., L.M., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (IDI) (C.A., R.M., A.d.B., A.R.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital, University of Toronto, Canada
| | - Raquel Mitjana
- From Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (CEMCAT) (G.A., M.T., J.R., J.C., A.V.-J., I.G., C.N., M.C., P.M., B.R.-A., L.M., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (IDI) (C.A., R.M., A.d.B., A.R.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital, University of Toronto, Canada
| | - Patricia Mulero
- From Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (CEMCAT) (G.A., M.T., J.R., J.C., A.V.-J., I.G., C.N., M.C., P.M., B.R.-A., L.M., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (IDI) (C.A., R.M., A.d.B., A.R.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital, University of Toronto, Canada
| | - Andrea de Barros
- From Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (CEMCAT) (G.A., M.T., J.R., J.C., A.V.-J., I.G., C.N., M.C., P.M., B.R.-A., L.M., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (IDI) (C.A., R.M., A.d.B., A.R.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital, University of Toronto, Canada
| | - Breogán Rodríguez-Acevedo
- From Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (CEMCAT) (G.A., M.T., J.R., J.C., A.V.-J., I.G., C.N., M.C., P.M., B.R.-A., L.M., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (IDI) (C.A., R.M., A.d.B., A.R.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital, University of Toronto, Canada
| | - Luciana Midaglia
- From Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (CEMCAT) (G.A., M.T., J.R., J.C., A.V.-J., I.G., C.N., M.C., P.M., B.R.-A., L.M., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (IDI) (C.A., R.M., A.d.B., A.R.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital, University of Toronto, Canada
| | - Jaume Sastre-Garriga
- From Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (CEMCAT) (G.A., M.T., J.R., J.C., A.V.-J., I.G., C.N., M.C., P.M., B.R.-A., L.M., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (IDI) (C.A., R.M., A.d.B., A.R.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital, University of Toronto, Canada
| | - Alex Rovira
- From Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (CEMCAT) (G.A., M.T., J.R., J.C., A.V.-J., I.G., C.N., M.C., P.M., B.R.-A., L.M., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (IDI) (C.A., R.M., A.d.B., A.R.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital, University of Toronto, Canada
| | - Xavier Montalban
- From Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (CEMCAT) (G.A., M.T., J.R., J.C., A.V.-J., I.G., C.N., M.C., P.M., B.R.-A., L.M., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (IDI) (C.A., R.M., A.d.B., A.R.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital, University of Toronto, Canada.
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