• Melissa Lynne Martin, Quy Cao, Elaina Luskin, Brian Renner, Lynn Daboul, Carly M O'Donnell, Paulo Rodrigues, John Derbyshire, Christina J Azevedo, Amit Bar-Or, Eduardo Caverzasi, Peter Calabresi, CreeBruce A CBACDepartment of Neurology, Weill Institute for Neurosciences, University of California at San Francisco, San Francisco, California, USA., Léorah Freeman, Roland G Henry, Erin E Longbrake, Jiwon Oh, Nico Papinutto, Daniel Pelletier, Vesna Prchkovska, Marc Ramos, Rohini D Samudralwar, Matthew K Schindler, Elias S Sotirchos, Nancy L Sicotte, Andrew J Solomon, Daniel S Reich, Daniel Ontaneda, Russell T Shinohara, and Pascal Sati.
• Penn Statistics in Imaging and Visualization Endeavor, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
• J Neuroimaging. 2025 Jan 1; 35 (1): e70011e70011.

Background And PurposeThe central vein sign (CVS) is a diagnostic imaging biomarker for multiple sclerosis (MS). FLAIR* is a combined MRI contrast that provides high conspicuity for CVS at 3 Tesla (3T), enabling its sensitive and accurate detection in clinical settings. This study evaluated whether CVS conspicuity of 3T FLAIR* is reliable across imaging sites and MRI vendors and whether gadolinium (Gd) contrast increases CVS conspicuity.MethodsA cross-sectional, multicenter study recruited adults referred for possible diagnosis of MS at 10 sites. FLAIR* contrast was generated using high-resolution T2*-weighted (acquired pre- and post-injection of Gd) and T2-weighted fluid-attenuated inversion recovery (T2-FLAIR) brain images at 3T from two MRI vendors. Lesions and veins were segmented to compute lesion-to-vein contrast-to-noise ratio (CNRlesion-to-vein), a quantitative measure of CVS conspicuity. CNRlesion-to-vein measures for pre- and post-Gd FLAIR* were compared across sites and vendors.ResultsEighty-seven participants from nine sites were included in the analysis. There was no significant difference in mean CNRlesion-to-vein between sites for pre-Gd (p-value = 0.07) or post-Gd (p-value = 0.27) FLAIR*. There were also no significant differences between vendors for pre-Gd (p-value = 0.10) or post-Gd (p-value = 0.31) FLAIR*. Patient-level pairwise differences in CNRlesion-to-vein between pre-Gd and post-Gd FLAIR* revealed a significant increase for post-Gd FLAIR* (p-value < 0.001).ConclusionsCVS conspicuity on 3T FLAIR* is consistent across imaging sites and MRI vendors. Moreover, Gd-based contrast agent significantly improved CVS conspicuity on 3T FLAIR*. These findings support the implementation of FLAIR* in clinical settings for MS.© 2025 American Society of Neuroimaging. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.

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