Evidence map›Paper›PMID 41628503›Full record

ArticleEuropean journal of radiology2026

Comparison of central FLAIR hypointensity and central vein sign on FLAIR* in a diagnostic cohort.

Karlo Toljan, Moein Amin, Lynn Daboul, Kunio Nakamura, Andrew J Solomon, Nancy L Sicotte, Russell T Shinohara, Daniel S Reich, Pascal Sati, Daniel Ontaneda

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in European journal of radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Karlo ToljanMellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, USA.
Moein AminMellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, USA.
Lynn DaboulTranslational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA; Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA; Department of Neurology, Brigham and Women's Hospital, MA, USA.
Kunio NakamuraDepartment of Biomedical Engineering, Cleveland Clinic Research, Cleveland Clinic, Cleveland, USA.
Andrew J SolomonDepartment of Neurological Sciences, Larner College of Medicine, University of Vermont, Burlington, VT, USA.
Nancy L SicotteDepartment of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Russell T ShinoharaDepartment of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Penn Statistics in Imaging and Visualization Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Center for AI and Data Science for Integrated Diagnostics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Daniel S ReichTranslational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
Pascal SatiDepartment of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Daniel OntanedaMellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, USA. Electronic address: ontaned@ccf.org.

Funding

Multimodal MRI in Multiple SclerosisZIANS003119 · NINDS · NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE · PI REICH, DANIEL · 2010 to 2025
$53.4M
Harmonization of Multi-Site Neuroimaging Data from Complex Study DesignsR01MH123550 · NIMH · UNIVERSITY OF PENNSYLVANIA · PI SHINOHARA, RUSSELL TAKESHI · 2020 to 2025
$4.0M
Advanced Statistical Analytics of MRI in MSR01NS112274 · NINDS · UNIVERSITY OF PENNSYLVANIA · PI SHINOHARA, RUSSELL TAKESHI · 2020 to 2024
$2.8M
Intramural NIH HHS ZIA NS003119NIMH NIH HHS R01 MH123550NINDS NIH HHS R01 NS112274
6 · The paper itself

Abstract

backgroundThe central vein sign (CVS) is a neuroimaging biomarker in multiple sclerosis (MS) with high diagnostic specificity. CVS is best detected with high-quality susceptibility-sensitive MRI sequences. For concurrent detection of lesions and veins, FLAIR* was developed as a post-processing method to provide contrast for T2 hyperintense lesions (FLAIR) and paramagnetic hypointense veins (T2*-weighted). Occasionally, CVS-like features have been noted on FLAIR, but the reliability of this finding is unknown.

objectiveTo compare the central FLAIR hypointensity to FLAIR* CVS.

methodsScans from the CentrAl Vein Sign in MS (CAVS-MS) pilot study were included for the analysis. A blinded rater assessed all lesions for CVS on 3-tesla post-contrast FLAIR*. A second blinded rater assessed the same lesions for central hypointensity on FLAIR images alone. Counts were compared between methods. The same approach was applied for a subset with available non-contrast FLAIR* lesion ratings.

resultsWith post-contrast FLAIR* CVS as the standard (n= 92; 1737 lesions), central FLAIR hypointensity demonstrated concordance of 64%, with sensitivity of 34% (95% CI, 30-37%) and specificity of 83% (95% CI, 81-85%). With non-contrast FLAIR* CVS as the standard (n= 38; 768 lesions), FLAIR demonstrated sensitivity of 40% (95% CI, 33-47%) and specificity of 85% (95% CI, 82-88%). Select 6 (≥6 central hypointense lesions) FLAIR was 59% accurate for a diagnosis of MS, with a lower specificity (63% vs. 90%, p= 0.008) in comparison to post-contrast FLAIR*.

conclusionsAssessment of CVS on FLAIR alone is unreliable and requires susceptibility-sensitive sequences to be clinically useful.

Indexed as

Cerebral VeinsImage Interpretation, Computer-AssistedMagnetic Resonance ImagingMultiple SclerosisAdultCohort StudiesFemaleHumansImage EnhancementMaleMiddle AgedPilot ProjectsReproducibility of ResultsSensitivity and SpecificityBiomarkersCentral vein signMRIMultiple sclerosis

Identifiers

PMID41628503
PMCPMC13390084

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.