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The MRI central vein marker: differentiating PPMS from RRMS and ischaemic SVD

Samaraweera, Amal P.R.; Falah, Yasser; Pitot, Alain; Dineen, Robert A.; Morgan, Paul S.; Evangelou, Nikos


Amal P.R. Samaraweera

Yasser Falah

Alain Pitot

Paul S. Morgan


© 2018 The Author(s). Objective To determine whether the assessment of brain white matter lesion (WML) central veins differentiate patients with primary progressive MS (PPMS) from relapsing-remitting MS (RRMS) and ischemic small vessel disease (SVD) using 3T MRI. Methods In this cross-sectional study, 71 patients with PPMS, RRMS, and SVD were imaged using a T2∗-weighted sequence. Two blinded raters identified the total number of WMLs, proportion of WMLs in periventricular, deep white matter (DWM) and juxtacortical regions, and proportion of WMLs with central veins in all patient groups. The proportions were compared between disease groups, including effect sizes. MS or SVD was categorized using a threshold of =40% WMLs with central veins as indicative of MS. Interrater and intrarater reproducibility was calculated. Results The mean proportion of WMLs with central veins was 68.4% in PPMS, 74.3% in RRMS, and 4.7% in SVD. The difference in proportions between PPMS and SVD groups was significant (p < 0.0005; effect size: 3.8) but not significant between MS subtypes (p = 0.3; effect size: 0.29). Distribution of WMLs was similar across both MS groups, but despite SVD patients having more DWM lesions than PPMS patients, proportions of WMLs with central veins remained low (2.75% in SVD; 62.5% in PPMS). Interrater and intrarater reproducibility comparing proportions of WMLs with central veins across all patients was 0.86 and 0.90, respectively. Level of agreement between the proportion of WML central veins and established diagnosis was 0.84 and 0.82 for each rater. Conclusions WML central veins could be used to differentiate PPMS from SVD but not between MS subtypes.


Samaraweera, A. P., Falah, Y., Pitot, A., Dineen, R. A., Morgan, P. S., & Evangelou, N. (2018). The MRI central vein marker: differentiating PPMS from RRMS and ischaemic SVD. Neurology, Neuroimmunology and Neuroinflammation, 5(6),

Journal Article Type Article
Acceptance Date Jun 28, 2018
Online Publication Date Sep 26, 2018
Publication Date Nov 1, 2018
Deposit Date Sep 19, 2018
Publicly Available Date Oct 29, 2018
Journal Neurology, Neuroimmunology and Neuroinflammation
Electronic ISSN 2332-7812
Publisher Lippincott, Williams & Wilkins
Peer Reviewed Peer Reviewed
Volume 5
Issue 6
Article Number e496
Public URL
Publisher URL


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