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Nat Rev Neurol. 2016 Dec;12(12):714-722. doi: 10.1038/nrneurol.2016.166. Epub 2016 Nov 11.

The central vein sign and its clinical evaluation for the diagnosis of multiple sclerosis: a consensus statement from the North American Imaging in Multiple Sclerosis Cooperative.

Author information

  • 1Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, NIH, 10 Center Drive MSC 1400, Building 10 Room 5C103, Bethesda, Maryland, USA.
  • 2St. Michael's Hospital, University of Toronto, Ontario, Canada.
  • 3Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA.
  • 4Department of Diagnostic Radiology, Yale University, New Haven, Connecticut, USA.
  • 5Division of Clinical Neuroscience, University of Nottingham, UK.
  • 6Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
  • 7Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA.
  • 8Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
  • 9Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
  • 10Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Italy.
  • 11Multiple Sclerosis Research Group, Department of Neurology, University of Texas Health Science Center at Houston, Texas, USA.
  • 12Mellen Center for MS Treatment and Research, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
  • 13Department of Pediatrics, Division of Neurology, UBC MRI Research Centre, University of British Columbia, Vancouver, Canada.
  • 14Advanced Imaging Research Center, Oregon Health &Science University, Portland, Oregon, USA.
  • 15Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
  • 16Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.
  • 17Department of Neurological Sciences, University of Vermont College of Medicine, Burlington, Vermont, USA.
  • 18Medical Image Analysis Center, University Hospital Basel, Switzerland.
  • 19Buffalo Neuroimaging Analysis Center, Department of Neurology, State University of New York at Buffalo, New York, USA.
  • 20Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
  • 21Multiple Sclerosis Center, Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.


Over the past few years, MRI has become an indispensable tool for diagnosing multiple sclerosis (MS). However, the current MRI criteria for MS diagnosis have imperfect sensitivity and specificity. The central vein sign (CVS) has recently been proposed as a novel MRI biomarker to improve the accuracy and speed of MS diagnosis. Evidence indicates that the presence of the CVS in individual lesions can accurately differentiate MS from other diseases that mimic this condition. However, the predictive value of the CVS for the development of clinical MS in patients with suspected demyelinating disease is still unknown. Moreover, the lack of standardization for the definition and imaging of the CVS currently limits its clinical implementation and validation. On the basis of a thorough review of the existing literature on the CVS and the consensus opinion of the members of the North American Imaging in Multiple Sclerosis (NAIMS) Cooperative, this article provides statements and recommendations aimed at helping radiologists and neurologists to better understand, refine, standardize and evaluate the CVS in the diagnosis of MS.

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