The central vein sign and iron rings: insights from a large cohort of patients with multiple sclerosis and mimicking disorders
ECTRIMS Online Library. Clarke M. 09/11/19; 279428; 108
Margareta Clarke
Margareta Clarke

Abstract: 108

Type: Young Scientific Investigators' Session

Abstract Category: Pathology and pathogenesis of MS - MRI and PET

M. Clarke1, L.M. Pessini Ferreira2,3, D. Pareto2,3, G. Arrambide3,4, M. Alberich1, F. Crescenzo5, A. Garcia Vidal1, M. Tintore3,4, C. Auger2,3, N. Evangelou6, A. Rovira1,2,3

1Vall d´Hebron Research Institute, 2Department of Radiology, Vall d´Hebron University Hospital, 3Universidad Autónoma de Barcelona, 4Centre d'Esclerosi Múltiple de Catalunya, (Cemcat), Vall d´Hebron University Hospital, Barcelona, Spain, 5Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy, 6Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom

Background: Susceptibility-weighted imaging (SWI) is an MRI technique that allows in vivo visualisation of venous blood & iron deposits. This technique enables identification of iron rings (IR) surrounding some white matter lesions (WMLs) and also the presence of the central vein sign (CVS), both of which have been proposed as MS-specific biomarkers. Previous studies have found that WMLs with IRs are more likely to enlarge, fail to remyelinate and appear to be absent in non-MS disorders. Large cohort studies are needed to further establish the role of IRs and CVS in MS.
Aims: To assess the prevalence of the CVS and IRs, detected on clinical, 3T SWI images, in a large cohort of patients with clinically isolated syndrome (CIS), relapsing-remitting (RR), progressive MS (PMS) and MS-mimicking disorders.
Methods: Patients from past/ongoing studies with clinical 3T 2D/3D FLAIR and 2D SWI were included. CIS patients were scanned within 6 months of the first attack. The prevalence of CVs and IRs was assessed and a negative binomial regression was used to predict the number of lesions with IRs in CIS & MS patients based on clinical and demographic characteristics.
Results: 112 CIS, 103 RR, 49 PMS and 35 non-MS patients were included. 2624 WMLs were analysed, including 1357 WMLs with CVS and 392 WMLs with IRs. 48% of CIS, 59% of RR and 39% of PMS patients had at least one IR and none of the non-MS patients had any IRs. RR patients had more IRs (median=1, range:0-22) than PMS patients (median=0,range: 0-10) and CIS (median=0,range:0-8). Median number of WMLs with CVS was 2.5 for CIS, 6 for RR, 3 for PMS and 1 in non-MS. None of the non-MS patients exceeded the 40% threshold of WMLs with CVs. WMLs with IRs and CVS were most common around the ventricles (58% of all WMLs with IRs and 39% of all WMLs with CVs). CVs were also common in subcortical WMLs (36.9% of all WMLs with CVs). The incidence rate of WMLs with IRs in females was 0.6x that in males (p< 0.001). CIS phenotype was predictive of a decreased number of IRs, compared to RR (p< 0.001), but not in PP (p=0.38), despite a downward trend.
Conclusions: IRs and CVS can be successfully visualized on clinical, 3T SWI images and appear to be highly specific to MS WMLs. Our results show that IRs numbers peak in RRMS and decrease with longer disease duration. Future longitudinal analyses, currently being undertaken at our centre, will help determine their contribution to disease progression and disability accumulation.
Disclosure: M. Clarke is a current ECTRIMS-MAGNIMS fellow and has received a speaker honorarium from Novartis.
L. Pessini Ferreira has nothing to disclose
D. Pareto has received speaking honoraria from Novartis and Biogen.
G. Arrambide has received compensation for consulting services or participation in advisory boards from Sanofi and Merck; research support from Novartis; travel expenses for scientific meetings from Novartis and Roche; and speaking honoraria from Stendhal, Sanofi and Merck.
M. Alberich has been sponsored by Novartis Farmacéutica S.A., Barcelona, Spain
F. Crescenzo has nothing to disclose
A. Garcia-Vidal has nothing to disclose
M. Tintore has received compensation for consulting services and speaking honoraria from Almirall, Bayer Schering Pharma, Biogen-Idec, Genzyme, Merck-Serono, Novartis, Roche, Sanofi-Aventis, and Teva Pharmaceuticals. MT is co-editor of Multiple Sclerosis Journal-ETC.
C. Auger has received speaking honoraria from Novartis, Stendhal and Biogen.
N.Evangelou has received compensation for consulting services and speaking honoraria from Biogen-Idec, Genzyme, Merck-Serono, Novartis, Roche, Sanofi-Aventis, and Teva Pharmaceuticals.
A. Rovira serves on scientific advisory boards for Novartis, Sanofi-Genzyme, Icometrix, SyntheticMR, Bayer, Biogen and OLEA Medical, and has received speaker honoraria from Bayer, Sanofi-Genzyme, Bracco, Merck-Serono, Teva Pharmaceutical Industries Ltd, Novartis, Roche and Biogen

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