The central vein sign and paramagnetic rim lesions: biomarkers for an accurate differential diagnosis between multiple sclerosis and migraine

Konzen, Viviana Regina; Finkelsztejn, Alessandro; Santos, Raquel Prates dos; Souza, Adolfo Moraes de; Ruffini, Matheus de Lima; Londero, Renata Gomes; Duarte, Juliana Ávila

doi:10.1590/0100-3984.2025.0015

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Original Article • Radiol Bras 58 • 2025 • https://doi.org/10.1590/0100-3984.2025.0015 linkcopy

The central vein sign and paramagnetic rim lesions: biomarkers for an accurate differential diagnosis between multiple sclerosis and migraine

Sinal da veia central e lesões com anel paramagnético: biomarcadores para um diagnóstico diferencial preciso entre esclerose múltipla e migrânea

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective: This study aimed to assess whether the evaluation of the central vein sign (CVS) and paramagnetic rim lesions (PRLs) using susceptibility-weighted magnetic resonance imaging (MRI) can distinguish multiple sclerosis (MS) from migraine.

Materials and Methods: In this single-center observational study, we conducted a cross-sectional analysis of the CVS, determining the proportion of CVS-positive lesions per individual and absolute counts, using thresholds of 3 lesions (select3*) and 6 lesions (select6*), and of PRLs in participants with MS and in those with migraine, from 3.0-T MRI brain scans.

Results: The study included 20 participants with MS, 20 with migraine, and 20 included as healthy controls. The proportion of participants with CVS-positive lesions was higher in the MS group than in the migraine group (61.8% vs. 10.4%), and PRLs were observed exclusively in the MS group. The presence of at least one PRL and the select6* criterion demonstrated the highest diagnostic accuracy within the study sample.

Conclusion: The detection of the CVS and of a PRL on 3.0-T MRI scans may serve as a reliable biomarker to differentiate MS from migraine.

Keywords:
Cerebral veins/diagnostic imaging; Multiple sclerosis/diagnosis; Migraine disorders/diagnosis; Neuroimaging/methods; Magnetic resonance imaging/methods; Biomarkers/analysis.

Characteristic	Group			p*
Characteristic	MS (n = 20)	Migraine (n = 20)	Control (n = 20)	p*
Age (years), mean ± SD	39.3 ± 14.5	42.5 ± 11.8	37.0 ± 11.5	0.459*
Sex, n (%)
Female	10 (50)^a	15 (75)^b	8 (40)^a	0.00†
Male	10 (50)	5(25)	12 (60)
MS subtype, n (%)
Relapsing-remitting	18 (90)	NA	NA
Primary progressive	1(5)	NA	NA
Secondary progressive	1(5)	NA	NA
EDSS score, mean ± SD	3.75 ± 2.07	NA	NA
Disease duration (years),
median (range)	5 (0-20)	NA	NA

Variable	Group
Variable	MS (n = 20)	Migraine (n = 20)	Control (n = 20)
Presence of lesions, n (%)	20 (100)	14 (70)	0(0)
Total number of lesions	1,697	96	0
Lesions per participant, median (range)	69 (22-221)	5(0-23)	0
CVS-positive lesions
Total, n (%)	1,048 (61.8)	10 (10.4)	0
Range (%-%)	20.9-94.9	0-100*	0
Number per participant, median (range)	37.5(12-135)	0(0-3)	0
PRLs
Participants with ≥ 1 PRL, n (%)	20 (100)	0	0
Total, n (%)	605 (35.7)	0	0
Range (%-%)	6.3-82.8	0	0
Number per participant, median (range)	13.5 (2-130)	0	0

Group			Control	p*
Brain region	MS	Migraine	Control	p*
All lesions†, median (range)
Periventricular	15 (6-52)^a	O(O-l)^b	0 (O-O)^b	< 0.001
Subcortical/DWM	37 (12-162)^a	4 (0-23)^b	0 (0-0)^c	< 0.001
Cortical	4(l-27)^a	O(O-l)^b	0 (O-O)^b	< 0.001
Infratentorial	4.5 (0-36)^a	O(O-l)^b	0 (O-O)^b	< 0.001
Total	69 (22-221)^a	5 (0-23)^b	0 (0-0)^c	< 0.001
CVS-positive lesions†, median (range)
Periventricular	9.5 (3-52)^a	O(O-l)^b	0 (O-O)^b	< 0.001
Subcortical/DWM	17 (4-88)^a	0 (0-3)^b	0 (O-O)^b	< 0.001
Cortical	1.5 (0-15)^a	0 (0-0)^b	0 (O-O)^b	< 0.001
Infratentorial	3.5 (0-36)^a	O(O-l)^b	0 (O-O)^b	< 0.001
Total	37.5(12-135)^a	0 (0-3)^b	0(0-0^b	< 0.001
PRLs¹, median (range)
Periventricular	5 (0-30)^a	0 (0-0)^b	0 (O-O)^b	< 0.001
Subcortical/DWM	6 (0-84)^a	O(O-O)^b	0 (O-O)^b	< 0.001
Cortical	l(0-12)^a	0(0-0)^b	0 (O-O)^b	< 0.001
Infratentorial	2 (0-36)^a	0 (O-O)^b	0 (O-O)^b	< 0.001
Total	13.5 (2-130)^a	0 (0-0)^b	0 (O-O)^b	< 0.001

Criterion	Sensitivity	Specificity	PPV	NPV	Accuracy
Select3^*	100.0%	97.1%	95.2%	100.0%	98.2%
Select6^*	100.0%	100.0%	100.0%	100.0%	100.0%
CVS threshold
30%	95.0%	78.6%	86.4%	91.7%	88.2%
35%	90.0%	78.6%	85.7%	84.6%	82.4%
40%	80.0%	78.6%	84.2%	73.3%	79.4%
50%	70.0%	92.9%	93.3%	68.4%	79.4%
> 1 PRL	100.0%	100.0%	100.0%	100.0%	100.0%

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[TFN1] ^*
Analysis of variance.

[TFN2] ^†
Chi-square test followed by the z-test for proportions.

[TFN3] ^a,b
Different letters represent statistically significant differences.

[4] NA, not applicable.