Abstract Details

Title The Central Vein Sign and Paramagnetic Rim Sign in White Matter Lesions of Radiolog-ically Isolated Syndrome

Topic Multiple Sclerosis

Presentation(s) S6 - MS and CNS Inflammatory Disease: Clinical Considerations I (1:22 PM-1:33 PM)

Poster/Presentation
Number 003

Objective

To assess for the presence of the central vein sign(CVS) and paramagnetic rim sign(PRS) in white matter lesions(WML)of radiologically isolated syndrome(RIS).

Background

RIS describes asymptomatic individuals with incidental radiologic abnormalities suggestive of multiple sclerosis(MS). Recent susceptibility-based MRI studies demonstrate that a significant proportion of WMLs in MS patients have visible central vein sign(CVS),which can assist in differentiating MS from other white-matter disorders. Furthermore,a subgroup of chronic MS lesions can demonstrate an increase in magnetic susceptibility along the lesion rim(paramagnetic rim sign(PRS)),which may represent chronic,active inflammation.

Design/Methods

15 individuals with RIS underwent 3.0T MRI to obtain 3D-FLAIR and 3D-T2*EPI. The CVS and PRS were assessed in WMLs on T2*magnitude and phase images.

Results All of the RIS cases recruited in this study had WMLs positive for the CVS(CVS+). The mean proportion of CVS+WMLs per case was 83%. 14(93%) had central veins in>40% of WML,meeting one proposed threshold to distinguish MS from other disorders. The PRS was present in 11 cases(73%),and the mean proportion of WMLs positive for the PRS(PRS+) per case was 19%. PRS were absent in 4 RIS cases(27%):3 had low total lesion loads(9-25 WMLs),and 1 had the lowest proportion of CVS+WML(31%). There were strong correlations between proportions of CVS+WML and PRS+WML(rho=0.86, p<0.001).

Conclusions In our sample, most RIS cases had a large proportion of CVS+WMLs,indicating perivenular pathology. Furthermore, a large(though smaller) proportion also had PRS+WMLs. RIS cases without PRS had low WML load and/or low proportions of CVS+WML. These findings suggest that the majority of RIS subjects harbor subclinical chronic active demyelination and may be at risk of eventually developing progressive clinical symptoms. Both CVS and PRS could potentially be useful to differentiate true RIS from mimickers. Prospective follow-up of this cohort is planned,which will enable a better understanding of the differential diagnostic and predictive value of the CVS and PRS in RIS.

Authors/Disclosures
Jiwon Oh, MD, FAAN (St Michael's Hospital) PRESENTER	Dr. Oh has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Roche. The institution of Dr. Oh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen-Idec. Dr. Oh has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for EMD-Serono. Dr. Oh has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi-Genzyme. Dr. Oh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Oh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eli Lilly. Dr. Oh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen. Dr. Oh has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Oh has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen-Idec. Dr. Oh has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi-Genzyme. The institution of Dr. Oh has received research support from Biogen-Idec. The institution of Dr. Oh has received research support from Roche.
	No disclosure on file
Melanie Guenette	No disclosure on file
Martina Absinta, MD	Dr. Absinta has received personal compensation in the range of $500-$4,999 for serving as a Consultant for GSK. Dr. Absinta has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abata Therapeutics. The institution of Dr. Absinta has received research support from International MS Alliance. The institution of Dr. Absinta has received research support from FRRB Early Career Award. The institution of Dr. Absinta has received research support from Cariplo Foundation.
Daniel Reich, MD, PhD (National Institutes of Health, Neuroimmunology Branch, NINDS)	Dr. Reich has received research support from NIH. The institution of Dr. Reich has received research support from Adelson Medical Research Foundation. The institution of Dr. Reich has received research support from Sanofi. The institution of Dr. Reich has received research support from Abata Therapeutics. The institution of Dr. Reich has received research support from National Multiple Sclerosis Society. The institution of Dr. Reich has received research support from Cure Alzheimer's Fund. Dr. Reich has received intellectual property interests from a discovery or technology relating to health care. Dr. Reich has received personal compensation in the range of $5,000-$9,999 for serving as a CME Faculty with Integrity. Dr. Reich has received personal compensation in the range of $500-$4,999 for serving as a CME Faculty with Letters and Sciences. Dr. Reich has received personal compensation in the range of $500-$4,999 for serving as a CME Faculty with Academic CME. Dr. Reich has a non-compensated relationship as a Advisor with Sanofi that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Board of Directors with ACTRIMS that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Advisor with Abata Therapeutics that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Advisor with University of Basel RC2NB that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Advisor with Multiple Sclerosis Society of Canada that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Advisor with Tuscan Doctorate in Neuroscience that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Editorial Board with Multiple Sclerosis Journal that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Collaborator, Advisor with Hyperfine that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Collaborator with Imaginab that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Collaborator with Annexon that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Collaborator, Advisor with Philips that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Collaborator with Siemens that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Advisor with Calico Life Sciences that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Advisor with Cognito Therapeutics that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Advisor with Sudo that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Advisor with Allumis that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Advisor with BioCentury that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Collaborator with Regeneron that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Collaborator with Eli Lilly that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Advisor with SetPoint that is relevant to AAN interests or activities.
	No disclosure on file
	No disclosure on file

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