Diagnostic performance of central vein sign versus oligoclonal bands for multiple sclerosis

Karlo Toljan; Lynn Daboul; Praneeta Raza; Melissa L Martin; Quy Cao; Carly M O'Donnell; Paulo Rodrigues; John Derbyshire; Christina J Azevedo; Amit Bar-Or; Eduardo Caverzasi; Peter A Calabresi; Bruce Ac Cree; Leorah Freeman; Roland G Henry; Erin E Longbrake; Jiwon Oh; Nico Papinutto; Daniel Pelletier; Rohini D Samudralwar; Matthew K Schindler; Elias S Sotirchos; Nancy L Sicotte; Andrew J Solomon; Russell T Shinohara; Daniel S Reich; Pascal Sati; Daniel Ontaneda

doi:10.1177/13524585241271988

Diagnostic performance of central vein sign versus oligoclonal bands for multiple sclerosis

Mult Scler. 2024 Sep;30(10):1268-1277. doi: 10.1177/13524585241271988. Epub 2024 Sep 5.

Authors

Karlo Toljan^{1

2}, Lynn Daboul^{3

4}, Praneeta Raza², Melissa L Martin^{5

6}, Quy Cao^{5

6}, Carly M O'Donnell^{5

6}, Paulo Rodrigues⁷, John Derbyshire⁸, Christina J Azevedo⁹, Amit Bar-Or¹⁰, Eduardo Caverzasi^{11

12}, Peter A Calabresi¹³, Bruce Ac Cree¹¹, Leorah Freeman¹⁴, Roland G Henry¹¹, Erin E Longbrake¹⁵, Jiwon Oh¹⁶, Nico Papinutto¹¹, Daniel Pelletier⁹, Rohini D Samudralwar^{10

17}, Matthew K Schindler¹⁰, Elias S Sotirchos¹³, Nancy L Sicotte¹⁸, Andrew J Solomon¹⁹, Russell T Shinohara^{5

6

20}, Daniel S Reich³, Pascal Sati^{3

18}, Daniel Ontaneda²

Affiliations

¹ Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
² Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
³ Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
⁴ Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA/Department of Neurology, Brigham and Women's Hospital, MA, USA.
⁵ Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
⁶ Penn Statistics in Imaging and Visualization Endeavor, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
⁷ QMENTA, Boston, MA, USA.
⁸ Functional MRI Facility, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
⁹ Department of Neurology, University of Southern California, Los Angeles, CA, USA.
¹⁰ Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
¹¹ Weill Institute for Neurosciences, Department of Neurology, University of California at San Francisco, San Francisco, CA, USA.
¹² Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
¹³ Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
¹⁴ Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, USA.
¹⁵ Department of Neurology, Yale University, New Haven, CT, USA.
¹⁶ Division of Neurology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
¹⁷ Department of Neurology, University of Texas Health Science Center, Houston, TX, USA.
¹⁸ Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
¹⁹ Department of Neurological Sciences, Larner College of Medicine, University of Vermont, Burlington, VT, USA.
²⁰ Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

Abstract

Background: Cerebrospinal fluid (CSF) oligoclonal bands (OCB) are a diagnostic biomarker in multiple sclerosis (MS). The central vein sign (CVS) is an imaging biomarker for MS that may improve diagnostic accuracy.

Objectives: The objective of the study is to examine the diagnostic performance of simplified CVS methods in comparison to OCB in participants with clinical or radiological suspicion for MS.

Methods: Participants from the CentrAl Vein Sign in MS (CAVS-MS) pilot study with CSF testing were included. Select-3 and Select-6 (counting up to three or six CVS+ lesions per scan) were rated on post-gadolinium FLAIR* images. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value for Select-3, Select-6, OCB, and combinations thereof were calculated for MS diagnosis at baseline and at 12 months.

Results: Of 53 participants, 25 were OCB+. At baseline, sensitivity for MS diagnosis was 0.75 for OCB, 0.83 for Select-3, and 0.71 for Select-6. Specificity for MS diagnosis was 0.76 for OCB, 0.48 for Select-3, and 0.86 for Select-6. At 12 months, PPV for MS diagnosis was 0.95 for Select-6 and 1.00 for Select-6 with OCB+ status.

Discussion: Results suggest similar diagnostic performance of simplified CVS methods and OCB. Ongoing studies will refine whether CVS could be used in replacement or in conjunction with OCB.

Keywords: biomarker; central vein sign; diagnostic imaging; multiple sclerosis; oligoclonal bands.

Publication types

Comparative Study

MeSH terms

Adult
Biomarkers / cerebrospinal fluid
Cerebral Veins / diagnostic imaging
Female
Humans
Magnetic Resonance Imaging*
Male
Middle Aged
Multiple Sclerosis* / cerebrospinal fluid
Multiple Sclerosis* / diagnostic imaging
Oligoclonal Bands* / cerebrospinal fluid
Pilot Projects
Predictive Value of Tests
Sensitivity and Specificity

Substances

Oligoclonal Bands
Biomarkers

Abstract

Publication types

MeSH terms

Substances

Grants and funding