Giulia Silvestri, Luca Roccatagliata, Francesco Tazza, Simona Schiavi, Alberto Coccia, Monica Bandettini Di Poggio, Maria Cellerino, Alessio Signori, Cinzia Finocchi, Antonio Uccelli, Matilde Inglese, Caterina Lapucci
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引用次数: 0
Abstract
Objective: To investigate, in two cohorts including patients with multiple sclerosis (MS) and migraine, (i) the prevalence of the "central vein sign" (CVS), (ii) the spatial distribution of positive CVS (CVS+) lesions, (iii) the threshold of CVS+ lesions able to distinguish MS from migraine with high sensitivity and specificity.
Methods: A total of 70 patients with MS/clinically isolated syndrome and 50 age- and sex-matched patients with migraine underwent a 3-T magnetic resonance imaging scan. The CVS was evaluated according to current guidelines, excluding eight patients with migraine who did not show white matter (WM) lesions. A receiver operating characteristic curve analysis was performed to identify the best threshold in terms of proportion of CVS+ lesions and the absolute number of CVS+ lesions able to differentiate MS from migraine.
Results: Lesion volume was different between CVS+ and CVS negative lesions (median 1043 vs. 176.5 mm3 for MS cohort; median 35.1 vs. 52.2 mm3 for migraine cohort; p < 0.001 for all). A higher proportion of CVS+ lesions was associated with a higher probability of being diagnosed as MS (adjusted odds ratio 1.09, 95% confidence interval [CI] 1.04-1.14; p < 0.001). CVS+ lesion volume and number were higher in MS with respect to migraine, both considering the whole brain and its subregions (p < 0.001). The proportion of CVS+ lesions in juxtacortical and infratentorial areas was higher in MS than in migraine (p = 0.015 and p = 0.034, respectively). The best CVS proportion-based threshold able to differentiate MS from migraine was 35.0% (sensitivity 97.1%, specificity 85.7%) with an area under the curve of 0.95 (95% CI 0.90-1.00). The "select 6" rule seemed to be preferable in terms of specificity with respect to the "select 3" rule.
Conclusions: A CVS proportion-based threshold of 35.0% is capable of distinguishing MS from migraine with high sensitivity and specificity. The "select 6" algorithm may be useful in the clinical setting.
期刊介绍：
Headache publishes original articles on all aspects of head and face pain including communications on clinical and basic research, diagnosis and management, epidemiology, genetics, and pathophysiology of primary and secondary headaches, cranial neuralgias, and pains referred to the head and face. Monthly issues feature case reports, short communications, review articles, letters to the editor, and news items regarding AHS plus medicolegal and socioeconomic aspects of head pain. This is the official journal of the American Headache Society.
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