Purpose or Case Report: Clinical diagnosis of pediatric-onset multiple sclerosis (POMS) is challenging, and MRI diagnostic criteria has imperfect sensitivity and specificity. The central vein sign (CVS) is a promising marker for POMS, however, most literature evaluating the central vein sign in POMS utilizes only the axial fluid attenuated inversion recovery (FLAIR) and susceptibility weigted imaging (SWI) sequences. Many institutions do not perform the SWI routinely or only recently replaced gradient recalled echo (GRE) with SWI in standard protocols. We investigate whether it is possible to detect the CVS with the GRE sequence.
Methods & Materials: Patients aged 0-18 years with a diagnosis of MS were identified from the hospital electronic medical record. A pediatric neuroradiologist with 6 years of post-fellowship experience blinded to diagnosis reviewed MRI images to evaluate for CVS using FLAIR, SWI, and GRE. Statistical analysis was done to determine the number of CVS positive lesions detected on both SWI and GRE.
Results: A total of 51 patients with POMS confirmed by MacDonald Criteria were retrospectively reviewed. 65% of patients were female, and median age was 15 years. 16 patients had SWI sequences only, and 40 patients had GRE sequences only. The median lesion count for the SWI cohort was 4 (0-24), and the median count was 0 for the GRE cohort (0-3). 9 patients had both sequences, and while 8 were positive for CVS using the SWI sequence, only 2 had positive lesions on GRE.
Conclusions: In the evaluation of a pediatric patient with potential demyelinating disorder, SWI should be performed instead of GRE, as it yields increased sensitivity in assessing for the central vein sign, a radiologic marker for POMS.