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Central vein sign on MRI shows potential diagnostic value in pediatric-onset multiple sclerosisMRI Central Vein Sign May Help Identify Pediatric Multiple Sclerosis

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Key Takeaway
Note that the central vein sign may have diagnostic value in POMS, but further standardized research is required.

This meta-analysis evaluated the diagnostic accuracy of the central vein sign (CVS) on MRI in patients with pediatric-onset multiple sclerosis (POMS). The analysis included 128 patients across 5 studies, with 118 patients eligible for the meta-analysis. The primary finding was a CVS-positive rate ratio of 0.531 (95% CI: 0.346 to 0.715, p < 0.001). Other findings included a proportion of CVS-positive patients of 0.643 (95% CI: 0.253 to 1.032, p < 0.001) and a mean of 13.851 CVS-positive lesions (95% CI: 11.260 to 16.442, p = 0.829).

The authors noted that specific pediatric-specific criteria are required and that further prospective studies with standardized imaging are necessary. The current evidence is limited by these factors, and the role of CVS in differentiating POMS from other demyelinating disorders remains to be fully established.

Clinically, the CVS may have diagnostic value in POMS, but its utility as a specific biomarker is not yet confirmed. Practitioners should interpret these findings as preliminary evidence that requires further validation through standardized protocols.

How this fits prior evidence

This meta-analysis addresses a gap in the diagnostic imaging of pediatric-onset multiple sclerosis. While previous coverage noted that traditional Chinese medicine may modulate immune balance in multiple sclerosis and that digitally enhanced endpoints can improve clinical trial efficiency, this study specifically addresses the utility of the central vein sign as a diagnostic marker in the pediatric population.

Researchers analyzed data from 128 patients with pediatric-onset multiple sclerosis (POMS) to look at a specific MRI finding called the central vein sign (CVS). This study looked at how often this sign appears and how many lesions are associated with it in young patients.

The analysis found that about 64.3% of patients with POMS showed the central vein sign. The study also looked at the number of lesions and where they were located in the brain. While the results suggest the central vein sign could be useful for diagnosis, the researchers noted that more studies are needed to confirm its role.

It is important to note that this study was a meta-analysis of existing data and is not a new clinical trial. Because the study was small and lacked standardized imaging across all groups, the results are not yet enough to change standard medical practice. Doctors currently need more research to determine if this sign can reliably distinguish POMS from other similar conditions.

What this means for you:
The central vein sign on MRI may help identify POMS, but more research is needed to confirm its diagnostic use.

Common questions

How accurate is this MRI finding for children?

The study suggests the central vein sign could have diagnostic value for children with multiple sclerosis. However, the researchers noted that more prospective studies with standardized imaging are required to fully understand its role and how it compares to other similar conditions.

Is this a new way to treat pediatric MS?

No, this finding is about diagnosis, not treatment. The study looked at how the central vein sign appears on MRI scans to help identify the disease. It does not provide a new treatment or change how current medications are used for children.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedOct 2026
View Original Abstract ↓
BACKGROUND: Diagnosing multiple sclerosis (MS) in children is challenging due to overlap with other demyelinating disorders. The Central Vein Sign (CVS) is a promising MRI biomarker in adult MS, but its diagnostic role in pediatric-onset MS (POMS) remains unclear. This systematic review and meta-analysis provides the first focused evaluation of CVS accuracy in POMS diagnosis. PURPOSE: To systematically evaluate prevalence and diagnostic accuracy of the central vein sign in POMS. METHODS: Followed PRISMA-DTA guidelines, a systematic search was performed on publicly available databases (PubMed, Embase, and Scopus) up to November 2024. Studies measuring the CVS accuracy on MRI in POMS patients were included. Meta-analysis using Open Meta-Analyst software calculated pooled proportions of CVS positivity per patient, per lesion number, the CVS mean positive rate, and lesion distribution patterns across different brain regions. RESULTS: Five studies (n = 128; mean age 11.4-15.6 years, 34,4% male, disease duration 0.8-1.6 years) met inclusion criteria, of which four (n = 118) were eligible for meta-analysis. The pooled proportion of CVS-positive patients was 0.643 (95% CI: 0.253 to 1.032, p < 0.001), and the pooled number of CVS-positive lesions was 13.851 (95% CI: 11.260 to 16.442, p = 0.829). The mean of the CVS-positive rate ratio was 0.531 (95% CI: 0.346 to 0.715, p < 0.001). Regional analysis revealed the highest CVS lesion burden in periventricular regions (mean = 4.62, 95% CI: 3.39-5.85, p = 0.249). CONCLUSION: This systematic review and meta-analysis suggests that the central vein sign could be of diagnostic value in POMS, but pediatric-specific criteria are needed. Further prospective studies with standardized imaging are required to establish the role of CVS in differentiating POMS from other demyelinating disorders.
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