BACKGROUND The central vein sign (CVS) is an imaging biomarker able to differentiate multiple sclerosis (MS) from other conditions causing similar appearance lesions on magnetic resonance imaging (MRI), including cerebral small vessel disease (CSVD). However, the impact of vascular risk factors (VRFs) for CSVD on the percentage of CVS positive (CVS+) lesions in MS has never been evaluated. OBJECTIVE To investigate the association between different VRFs and the percentage of CVS+ lesions in MS. METHODS In 50 MS patients, 3T brain MRIs (including high-resolution 3-dimensional T2*-weighted images) were analyzed for the presence of the CVS and MRI markers of CSVD. A backward stepwise regression model was used to predict the combined predictive effect of VRF (i.e. age, hypertension, diabetes, obesity, ever-smoking, and hypercholesterolemia) and MRI markers of CSVD on the CVS. RESULTS The median frequency of CVS+ lesions was 71% (range: 35%-100%). In univariate analysis, age (p < 0.0001), hypertension (p < 0.001), diabetes (p < 0.01), obesity (p < 0.01), smoking (p < 0.05), and the presence of enlarged-perivascular-spaces on MRI (p < 0.005) were all associated with a lower percentage of CVS+ lesions. The stepwise regression model showed that age and arterial hypertension were both associated with the percentage of CVS+ lesions in MS (adjusted R2 = 0.46; p < 0.0001 and p = 0.01, respectively). CONCLUSION The proportion of CVS+ lesions significantly decreases in older and hypertensive MS patients. Although this study was conducted in patients with an already established MS diagnosis, the diagnostic yield of the previously proposed 35% CVS proportion-based diagnostic threshold appears to be not affected. Overall these results suggest that the presence of VRF for CSVD should be taken into account during the CVS assessment.

中文翻译：

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多发性硬化合并血管疾病患者的中心静脉征

背景 中央静脉征 (CVS) 是一种成像生物标志物，能够将多发性硬化症 (MS) 与在磁共振成像 (MRI) 上引起相似外观病变的其他病症区分开来，包括脑小血管病 (CSVD)。然而，从未评估过 CSVD 的血管危险因素 (VRF) 对 MS 中 CVS 阳性 (CVS+) 病变百分比的影响。目的 研究不同 VRF 与 MS 中 CVS+ 病变百分比之间的关联。方法 在 50 名 MS 患者中，分析 3T 脑部 MRI（包括高分辨率 3 维 T2* 加权图像）是否存在 CVS 和 CSVD 的 MRI 标志物。使用后向逐步回归模型来预测 VRF（即年龄、高血压、糖尿病、肥胖、吸烟、和高胆固醇血症）和 CVS 上 CSVD 的 MRI 标志物。结果 CVS+ 病变的中位频率为 71%（范围：35%-100%）。在单变量分析中，年龄（p < 0.0001）、高血压（p < 0.001）、糖尿病（p < 0.01）、肥胖（p < 0.01）、吸烟（p < 0.05）和 MRI 上血管周围间隙扩大的存在(p < 0.005) 都与较低百分比的 CVS+ 病变相关。逐步回归模型显示，年龄和动脉高血压均与 MS 中 CVS+ 病变的百分比相关（调整后的 R2 = 0.46；分别为 p < 0.0001 和 p = 0.01）。结论老年和高血压MS患者CVS+病变的比例显着降低。尽管这项研究是在已确诊 MS 的患者中进行的，之前提出的基于 35% CVS 比例的诊断阈值的诊断率似乎不受影响。总的来说，这些结果表明在 CVS 评估期间应该考虑到 CSVD 的 VRF 的存在。