• Thomas Kau, Manuel Taschwer, Hannes Deutschmann, Martina Schönfelder, Jörg R Weber, and Klaus A Hausegger.
• Klinikum Klagenfurt, Institute of Diagnostic and Interventional Radiology, Feschnigstrasse 11, 9020 Klagenfurt, Austria. t.kau@gmx.at
• Eur Radiol. 2013 Jul 1; 23 (7): 1956-62.

ObjectivesSusceptibility weighted imaging (SWI) may have the potential to depict the perivenous extent of white matter lesions (WMLs) in multiple sclerosis (MS). We aimed to assess the discriminatory value of the "central vein sign" (CVS).MethodsIn a 3-T magnetic resonance imaging (MRI) study, 28 WMLs in 14 patients with at least one circumscribed lesion >5 mm and not more than eight non-confluent lesions >3 mm were prospectively included. Only WMLs in FLAIR images with a maximum diameter of >5 mm were correlated to their SWI equivalent for CVS evaluation.ResultsFive patients fulfilled the revised McDonald criteria for MS and nine patients were given alternative diagnoses. Nineteen MS-WMLs and nine non-MS-WMLs >5 mm were detected. Consensus reading found a central vein in 16 out of 19 MS-WMLs (84 %) and in one out of nine non-MS-WMLs (11 %), respectively. The CVS proved to be a highly significant discriminator (P < 0.001) between MS-WMLs and non-MS-WMLs with a sensitivity, specificity, positive and negative predictive value and accuracy of 84 %, 89 %, 94 %, 73 % and 86 %, respectively. Inter-rater agreement was good (κ = 0.77).ConclusionsEven though the CVS is not exclusively found in MS-WMLs, SWI may be a useful adjunct in patients with possible MS.Key Points• MRI continues to yield further information concerning MS lesions. • SWI adds diagnostic information in patients with possible MS. • The "central vein sign" was predominantly seen in MS lesions. • The "central vein sign" helps discriminate between MS and non-MS lesions.

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