Over the past few years, MRI has become an indispensable tool for diagnosing multiple sclerosis (MS). However, the current MRI criteria for MS diagnosis have imperfect sensitivity and specificity. The central vein sign (CVS) has recently been proposed as a novel MRI biomarker to improve the accuracy and speed of MS diagnosis. Evidence indicates that the presence of the CVS in individual lesions can accurately differentiate MS from other diseases that mimic this condition. However, the predictive value of the CVS for the development of clinical MS in patients with suspected demyelinating disease is still unknown. Moreover, the lack of standardization for the definition and imaging of the CVS currently limits its clinical implementation and validation. On the basis of a thorough review of the existing literature on the CVS and the consensus opinion of the members of the North American Imaging in Multiple Sclerosis (NAIMS) Cooperative, this article provides statements and recommendations aimed at helping radiologists and neurologists to better understand, refine, standardize and evaluate the CVS in the diagnosis of MS.
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The authors would like to thank Christina J. Azevedo, Michael G. Dwyer, Léorah Freeman, Christoph Juchem, Shannon Kolind, Naila Makhani, Govind Nair, Nico Papinutto, Haochang Shou, Daniel Schwartz, Ferdinand Schweser, Elizabeth Sweeney, Ian Tagge, Shahamat Tauhid and Subhash Tummala for their participation in, and contribution to, the group workshop at the NAIMS meeting in Los Angeles. Matthew Schindler is acknowledged for helpful suggestions. The authors also acknowledge Rohit Bakshi, Peter Calabresi, Ciprian Crainiceanu and Jack Simon for their contribution as NAIMS members. The authors, on behalf of the NAIMS Cooperative, would also like to thank the Race to Erase Multiple Sclerosis for financial support, and Joel Arnold, Aracely Delgadillo, and Liz Seares for helping with organization of the NAIMS meeting. This research was supported in part by the Intramural Research Program of the National Institute of Neurological Disorders and Stroke.