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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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.</p><p><strong>Results: </strong>Lesion volume was different between CVS+ and CVS negative lesions (median 1043 vs. 176.5 mm<sup>3</sup> for MS cohort; median 35.1 vs. 52.2 mm<sup>3</sup> 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.</p><p><strong>Conclusions: </strong>A CVS proportion-based threshold of 35.0% is capable of distinguishing MS from migraine with high sensitivity and specificity. 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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.</p><p><strong>Results: </strong>Lesion volume was different between CVS+ and CVS negative lesions (median 1043 vs. 176.5 mm<sup>3</sup> for MS cohort; median 35.1 vs. 52.2 mm<sup>3</sup> 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.</p><p><strong>Conclusions: </strong>A CVS proportion-based threshold of 35.0% is capable of distinguishing MS from migraine with high sensitivity and specificity. 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引用次数: 0
摘要
目的：在多发性硬化症（MS）和偏头痛患者两组队列中，研究(i)“中央静脉征象”（CVS）的患病率，（ii） CVS阳性病变（CVS+）的空间分布，（iii） CVS+病变能够高灵敏度和特异性区分MS和偏头痛的阈值。方法：对70例MS/临床孤立综合征患者和50例年龄和性别匹配的偏头痛患者进行3-T磁共振成像扫描。CVS根据现行指南进行评估，排除了8名没有出现白质（WM）病变的偏头痛患者。进行受试者工作特征曲线分析，以确定CVS+病变的比例和CVS+病变的绝对数量来区分MS和偏头痛的最佳阈值。结果：CVS阳性和CVS阴性病变的体积不同(MS队列中位数为1043 mm3 vs 176.5 mm3；偏头痛队列的中位数为35.1 mm3 vs 52.2 mm3；结论：基于CVS比例的阈值为35.0%，能够以高灵敏度和特异性区分MS和偏头痛。“select 6”算法可能在临床环境中有用。
The "central vein sign" to differentiate multiple sclerosis from migraine.
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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