JAMA Neurol：高场磁共振显示的中性静脉征或可特异诊断多发性硬化

至今尚没有可以特异性诊断多发性硬化(MS)的单项特异性检查，现有的诊断标准也不尽完美，这对诊断来说是一种拖延。很多患者需要（有时是侵入性的）大量检查及长时间的临床随访来验证或是排除多发性硬化的诊断。一项病理上特异诊断多发性硬化炎症性脱髓鞘的生物标记物或能修正现有的诊断流程。

该研究拟用高场磁共振（7-T）检测临床怀疑但尚未诊断的多发性硬化患者，前瞻性评价病灶中央静脉征对多发性硬化的诊断价值，采用前瞻性纵向队列研究。参考标准为多发性硬化神经专科医生通过平均随访26月得出临床诊断。采用7-T MRI扫描基线数据寻找可视的中央静脉征，影像科医生对临床患者临床数据不知情。

连续登记专业MS参考中心29例诊断为可能MS的患者，这些患者均有临床MRI资料，但是临床及影像专家根据这些治疗均无法诊断为多发性硬化。采用7-T高场MRI T2*加权序列检查。统计根据研究开始时的7-T MRI数据最终正确诊断为MS或未诊断为MS比例，并与最终治疗医师在未知高场磁共振数据时最终诊断相对比。在纳入的29例采用7-T MRI扫面的患者中，至今有22例得出临床诊断。在最终诊断为MS的13例患者中，基线扫描时主要脑内大部分病灶均可见中央静脉征，在最终没有诊断为MS的患者中，只有很少一部分病灶出现中央静脉征。

该研究显示7-T MRI T2*加权相在诊断MS方面具有100%的阳性及阴性预测值。该诊断技术的临床应用或可以提高现有的MS诊断流程。

Central Veins in Brain Lesions Visualized With High-Field Magnetic Resonance Imaging: A Pathologically Specific Diagnostic Biomarker for Inflammatory Demyelination in the Brain.
Abstract
IMPORTANCE There is no single test that is diagnostic for multiple sclerosis (MS), and existing diagnostic criteria are imperfect. This can lead to diagnostic delay. Some patients require multiple (sometimes invasive) investigations, and extensive clinical follow-up to confirm or exclude a diagnosis of MS. A diagnostic biomarker that is pathologically specific for the inflammatory demyelination in MS could overhaul current diagnostic algorithms. OBJECTIVE To prospectively assess the diagnostic value of visualizing central veins in brain lesions with magnetic resonance imaging (MRI) for patients with possible MS for whom the diagnosis is uncertain. DESIGN Prospective longitudinal cohort study. The reference standard is a clinical diagnosis that is arrived at (after a mean follow-up of 26 months) by the treating neurologist with a specialist interest in MS. The 7-T MRI scans were analyzed at baseline, by physicians blinded to the clinical data, for the presence of visible central veins. SETTING Academic MS referral center. PARTICIPANTS A consecutive sample of 29 patients referred with possible MS who had brain lesions detected on clinical MRI scans but whose condition remained undiagnosed despite expert clinical and radiological assessments. EXPOSURE Seven-Tesla MRI using a T2*-weighted sequence. MAIN OUTCOMES AND MEASURES The proportion of patients whose condition was correctly diagnosed as MS or as not MS, using 7-T MRI at study onset, compared with the eventual diagnosis reached by treating physicians blinded to the result of the MRI scan. RESULTS Of the 29 patients enrolled and scanned using 7-T MRI, so far 22 have received a clinical diagnosis. All 13 patients whose condition was eventually diagnosed as MS had central veins visible in the majority of brain lesions at baseline. All 9 patients whose condition was eventually not diagnosed as MS had central veins visible in a minority of lesions. CONCLUSIONS AND RELEVANCE In our study, T2*-weighted 7-T MRI had 100% positive and negative predictive value for the diagnosis of MS. Clinical application of this technique could improve existing diagnostic algorithms.