11/21/2025
Emerging research suggests that a six-minute magnetic resonance imaging (MRI) exam for assessment of the central vein sign (CVS) provides similar sensitivity for multiple sclerosis (MS) as traditional evaluation for cerebrospinal fluid (CSF) oligoclonal bands (OCBs).
For the multicenter prospective study, recently published in Neurology, researchers compared T2-weighted brain MRI detection at a 40 percent threshold for the central vein sign (CVS) to assessment of CSF OCBs (which require a lumbar puncture) for detection of MS. The cohort was comprised of 99 participants (mean age of 38) who presented with a clinically isolated syndrome (CIS), according to the study.
The researchers found that employing the 40 percent CVS threshold for the six-minute MRI provided a 90 percent sensitivity for MS detection in comparison to 83.3 percent for CSF OCB testing. Using the “rule of 6” definition of CVS (seeing six or more lesions with a central venule) had a 91.3 percent sensitivity for MS detection, according to the study authors.
While CSF OCB offered 100 percent specificity for MS detection, the researchers noted that both the 40 percent threshold for CVS and the rule of 6 CVS definition had 57.1 percent specificity. However, the study authors also noted comparable positive predictive value (100 percent for CSF OCB, 96 percent for the 40 percent CVS threshold and 96.1 percent for the CVS rule of 6) and negative predictive value (35 percent for CSF OCB, 36.4 percent for the CVS rule of 6 and 33.3 percent for the CVS 40 percent threshold).
“Diagnostic (lumbar puncture), known to be associated with iatrogenic morbidity, has been used by many centers aiming to expedite the diagnosis of MS as per the 2017 (McDonald) modified diagnostic criteria. Our results demonstrate that the CVS, including the rule of 6, has equivalent sensitivity to OCB testing using a prospective, multicenter study of participants presenting with typical CIS,” wrote lead study author Christopher Martin Allen, M.D.
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