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MS – Central Vein Sign on MRI — SCE Neurology MCQ

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HardMultiple Sclerosis & CNS InflammationMS – Central Vein Sign on MRISCE Neurology

A 50-year-old woman with known MS is found to have a central vein sign within her white matter lesions on 3T MRI using T2*-weighted imaging. What is the significance of this finding?

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Correct answer: A — The central vein sign (a small central vein visible within ≥40% of white matter lesions) is a highly specific imaging biomarker for MS — it helps distinguish MS lesions from those caused by migraine, small vessel disease, and NMOSD

The central vein sign (CVS) reflects the perivenular distribution of MS lesions — MS plaques form around small veins. On susceptibility-weighted or T2*-weighted imaging (particularly at 3T or 7T), a small central vein is visible within the lesion. The '40% threshold' (≥40% of lesions showing CVS) has >90% specificity for MS vs non-MS white matter lesions. This helps differentiate MS from mimics (migraine, SVD, NMOSD) which do not show perivenular distribution. The central vein sign is being incorporated into proposed revisions of the McDonald criteria. A: It is highly clinically significant. C: Lymphoma has different characteristics. D: NMOSD lesions do not show CVS. E: Both active and chronic MS lesions show CVS.

Reference: MAGNIMS CVS Consensus; Proposed McDonald Criteria Revision; ABN MS Guidelines