Diagnostic performance of central vein sign, paramagnetic rim lesion and cortical lesion in Asian patients with multiple sclerosis

BACKGROUND: The 2024 revised McDonald criteria for multiple sclerosis (MS) incorporate central vein sign (CVS) and paramagnetic rim lesion (PRL), but their utility in Asian patients remains unclear. OBJECTIVE: To evaluate the performance of CVS, PRL and cortical lesion (CL) in distinguishing MS from neuromyelitis optica spectrum disorders (NMOSD) and myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD) in Japanese patients. METHODS: We conducted a cross-sectional study of 139 MS, 41 NMOSD and 12 MOGAD patients who underwent 3-Tesla magnetic resonance imaging (MRI), including susceptibility-weighted imaging. RESULTS: At least one CVS was identified in 95% of MS, 59% of NMOSD and 42% of MOGAD, while PRL occurred in 63% of MS only. The CVS number (cutoff ⩾ 2) yielded 85.6% sensitivity and 75.5% specificity (area under the curve (AUC) 0.856), which improved in patients