The Value Of Central Vein Sign At 3T In The Differential Diagnosis Of Multiple Sclerosis And Myelin Oligodendrocyte Glycoprotein Antibody Associated Disorders

Background: Multiple Sclerosis(MS)is an immune-mediated inflammatory demyelinating disease of the central nervous system,which is characterized by recurrent or progressive neurological symptoms and focal white matter lesions.Patients often have a relapse-remission process.As the course of the disease progresses,the degree of disability gradually accumulates,which seriously affects the patient’s quality of life and work ability.Due to the lack of specificity in the clinical manifestations of MS and the lack of a single highly accurate diagnostic test,its diagnosis is still a challenging clinical problem,and the diagnosis is still mainly based on exclusion of alternative diagnoses.In order to improve the recognition and diagnosis of MS,to start disease-modifying treatment as early as possible,and to delay the progress of patients with disabilities,scholars at home and abroad have conducted extensive and in-depth explorations,hoping to find biomarkers with better diagnostic efficacy.The Central Vein Sign(CVS)may be such a marker.Myelin oligodendrocyte glycoprotein antibody associated disorders(MOGAD)may have optic neuritis,myelitis and other demyelination events similar to MS.In many cases,the imaging performance is difficult to distinguish from MS.The identification of the two requires further research.Objective: In MS,Magnetic Resonance Imaging(MRI)is a sensitive tool for detecting white matter lesions,but its diagnostic specificity is still not ideal,and cases of uncertain diagnosis often occur in clinical practice.The emergence of CVS improves the pathological specificity of MS diagnosis,but CVS has not been tested in MOGAD.Therefore,in this study,we preliminarily explored the percentage of cvs in ms and mogad and its differential diagnostic value.Methods: 3 MS patients and 3 MOGAD patients underwent 3T MRI scan to obtain3 D T1-MAPRAGE and 3D T2-FLAIR images.For each lesion,we evaluated CVS according to the international consensus about CVS.We compared the lesions of different diseases and the shape of the central vein.The total number of lesions,the location of lesions and the percentage of CVS were evaluated for each patient.The inter-group comparisons were performed t independent samples or Mann –Whitney U tests.We used the receiver operating characteristic curve(ROC)to analyze the area under curve(AUC)of different CVS percentage differential MS and MOGAD to judge its diagnostic efficacy and obtain the best CVS cut-off value.Results:(1)Both MS and MOGAD lesions had a percentage of lesions with the CVS,of which MOGAD(89.33%)was higher than MS(81.45%)(p<0.05).There was no statistically significant difference between the two groups of patients in the percentage of lesions with the CVS of each brain region(p<0.05).Both MS and MOGAD have the largest number of CVS in subcortical/deep white matter sites(52%,49%,respectively).In MOGAD,the highest percentage of lesions with the CVS,out of the total number of lesions with the CVS,was seen in the subcortical or deep white matter location(49%),and in MS the highest percentage of lesions with the CVS was detected in the same location,too(52%).In a subanalysis by brain region,the highest percentage of lesions with the CVS in each brain region,out of the total number of lesions in the same location,in Ms is 97.67% in periventricular,while MOGAD is 100% in infratentorial.(2)In the morphology of the lesions,the edges of the lesions in MOGAD cases are generally more blurred than MS,and the central vein of the lesions is lighter than MS.(3)Applying roc statistical analysis,we found that 100% of MOGAD patients have a percentage of lesions with the CVS more than 87% and 100% of MS patients have a percentage of lesions with the CVS less than 87%.The best CVS cut-off value using 87% was used to distinguish the two,with a sensitivity of 100%,specificity of 100%,and AUC of 1(p<0.05).Conclusion: MOGAD,like MS,presents a high percentage of lesions with the CVS,suggesting that these two disorders may have similar pathological mechanisms.But their morphology and the main distribution of positive lesions are different.CVS may successfully identify MS and MOGAD under standard clinical magnetic field intensity(3 T).