Abstract Details

Title Evaluation of the “Three Lesions with a Central Vein Sign” Criteria for the Differentiation between Multiple Sclerosis and its Imaging Mimics

Topic Multiple Sclerosis

Presentation(s) S6 - MS and CNS Inflammatory Disease: Clinical Considerations I (1:11 PM-1:22 PM)

Poster/Presentation
Number 002

Background For differentiation between multiple sclerosis (MS) and non-MS, the central vein sign (CVS) was proposed as a specific and sensitive imaging biomarker, and recent studies have proposed criteria based on the proportion of lesions with CVS. Nevertheless, criteria that are based on the absolute numbers of lesions with CVS may are more applicable in clinical practice to improve differentiation between MS and its imaging mimics.

Objective To evaluate the sensitivity and specificity of CVS lesion criteria that are based on the absolute numbers of lesions with CVS in differentiating MS from non-MS conditions on clinical 3T brain MRI in a multi-center study.

Design/Methods

606 subjects with clinically isolated syndrome (CIS, n=117), relapsing-remitting MS (RRMS, n=236 of which108 had a disease duration shorter than 5 years), aquaporine-4 antibody positive NMOSD (n=32), systemic lupus erythematosus (n=25), migraine (n=29), cluster headache (n=5), diabetes mellitus (n=20), or other types of small vessel disease (n=142) were analysed. Occurrence of CVS was determined on 3T T2*weighted (T2*w) or susceptibility weighted imaging (SWI) by raters blinded to clinical data and lesion distribution. Sensitivity and specificity were assessed for different CVS lesion criteria that were defined based on the absolute numbers of lesions with CVS.

Results

In total, 4447 lesions were analyzed. The “two-CVS-lesions criterion” (two or more CVS lesions) had a sensitivity and specificity of 76.2%, and 79.3%, and the “three-CVS-lesions criterion” (three or more CVS lesions) had a sensitivity and specificity of 61.9%, and 89.0% in differentiating between RRMS/CIS and non-MS. The observed sensitivity and specificity values were consistent across all studied disease subgroups including CIS and early RRMS.

Conclusions The application of a “three-CVS-lesions criterion” seems feasible in clinical routine, and yields a high specificity and moderate sensitivity in differentiating MS from non-MS.

Authors/Disclosures
Tim Sinnecker PRESENTER	No disclosure on file
	No disclosure on file
Dominik S. Meier, PhD (Brigham & Women's Hospital)	No disclosure on file
Christian Enzinger	Christian Enzinger has nothing to disclose.
Massimiliano Calabrese (The Multiple Sclerosis Center, University Hospital of Verona)	Massimiliano Calabrese has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis Pharma. Massimiliano Calabrese has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck Serono. Massimiliano Calabrese has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Massimiliano Calabrese has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis Pharma. Massimiliano Calabrese has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Massimiliano Calabrese has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Genzyme. Massimiliano Calabrese has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for BMS Celgene. The institution of Massimiliano Calabrese has received research support from Roche.
Nicola De Stefano, MD (University of Siena)	Dr. De Stefano has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck Healthcare KGaA. Dr. De Stefano has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Immunic AG. Dr. De Stefano has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis Pharma AG. Dr. De Stefano has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck Serono S.p.A. Dr. De Stefano has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi Genzyme. Dr. De Stefano has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche S.p.A.. The institution of Dr. De Stefano has received research support from Italian MS Society. The institution of Dr. De Stefano has received research support from Merck Healthcare KGaA.
	No disclosure on file
Antonio Giorgio, MD	Dr. Giorgio has nothing to disclose.
	No disclosure on file
Friedemann Paul (Charite Universitatsmedizin in Berlin)	Dr. Paul has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Hexal. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Hexal. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Hoffmann-La Roche. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bristol-Myers Squibb GmbH & Co. KGaA (BMS. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Hexal. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Teva. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Horizon Therapeutics GmbH. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Hexal. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Paul has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB. Dr. Paul has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Roche. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Paul has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for UCB. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for sanofi. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche . Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for F&U Confirm. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Alexion. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bristol Myers Squibb GesmbH. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for MICE Service. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Alexion. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Alexion. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Amgen. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sanofi. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for VINDICO medical education. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Amgen. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for UCB. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sanofi. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Beijing Novartis. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sandoz Internation GmbH. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Amgen. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Alexion. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche Thailand. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche . Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Alexion.
Mikolaj Pawlak, MD PhD (Department of Neurology)	Dr. Pawlak has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Surgalign . Dr. Pawlak has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Dr. Pawlak has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Inteneural Networks Inc. Dr. Pawlak has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for RSQ. Dr. Pawlak has received publishing royalties from a publication relating to health care.
Ludwig Kappos, MD, FAAN (RC2NB, University Hospital Basel)	The institution of Dr. Kappos has received research support from Bayer. The institution of Dr. Kappos has received research support from Biogen. The institution of Dr. Kappos has received research support from Genentech. The institution of Dr. Kappos has received research support from Genzyme. The institution of Dr. Kappos has received research support from Janssen. The institution of Dr. Kappos has received research support from Merck Serono. The institution of Dr. Kappos has received research support from Minoryx. The institution of Dr. Kappos has received research support from Novartis. The institution of Dr. Kappos has received research support from Roche. The institution of Dr. Kappos has received research support from Sanofi. The institution of Dr. Kappos has received research support from Santhera. The institution of Dr. Kappos has received research support from Swiss MS Society, Swiss National Research Foundation, European Union, Roche Research Foundation, Innosuisse. The institution of Dr. Kappos has received research support from Shionogi. The institution of Dr. Kappos has received research support from Japan Tobacco. The institution of Dr. Kappos has received research support from Auriga Vision AG. The institution of Dr. Kappos has received research support from EMD Serono. The institution of Dr. Kappos has received research support from Glaxo Smith Kline. The institution of Dr. Kappos has received research support from Wellmera AG. The institution of Dr. Kappos has received research support from Eli Lilly (Suisse) SA. The institution of Dr. Kappos has received research support from Bristol Myers Squibb. The institution of Dr. Kappos has received research support from Celltrion Inc. Dr. Kappos has received intellectual property interests from a discovery or technology relating to health care.
Alex Rovira	Alex Rovira has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Alex Rovira has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofy. Alex Rovira has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Alex Rovira has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Alex Rovira has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Alex Rovira has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Alex Rovira has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Alex Rovira has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Alex Rovira has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen. Alex Rovira has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Alex Rovira has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bristol Myers. Alex Rovira has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bayer. Alex Rovira has stock in Tensor Medical.
Nikolaos Evangelou, PhD (Nottingham University, QMC campus)	Dr. Evangelou has received personal compensation in the range of $0-$499 for serving as a Consultant for Novartis . Dr. Evangelou has received personal compensation in the range of $0-$499 for serving as a Consultant for Novartis . The institution of Dr. Evangelou has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Roche. Dr. Evangelou has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck . Dr. Evangelou has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Evangelou has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen . Dr. Evangelou has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis . Dr. Evangelou has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for biogen. Dr. Evangelou has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merck. Dr. Evangelou has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Dr. Evangelou has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for UK crown prosecution service. Dr. Evangelou has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Novartis .
	No disclosure on file

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