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

Author:

Toljan Karlo12ORCID,Daboul Lynn34,Raza Praneeta2,Martin Melissa L56,Cao Quy56ORCID,O’Donnell Carly M56,Rodrigues Paulo7,Derbyshire John8,Azevedo Christina J9ORCID,Bar-Or Amit10ORCID,Caverzasi Eduardo1112ORCID,Calabresi Peter A13ORCID,Cree Bruce AC11ORCID,Freeman Leorah14,Henry Roland G11,Longbrake Erin E15,Oh Jiwon16ORCID,Papinutto Nico11,Pelletier Daniel9,Samudralwar Rohini D1017,Schindler Matthew K10,Sotirchos Elias S13ORCID,Sicotte Nancy L18,Solomon Andrew J19ORCID,Shinohara Russell T5620,Reich Daniel S3ORCID,Sati Pascal318ORCID,Ontaneda Daniel2ORCID

Affiliation:

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.

Funder

National Institute of Neurological Disorders and Stroke

Race to Erase Multiple Sclerosis Foundation

NIH Medical Research Scholars Program

Publisher

SAGE Publications

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