Characterizing Lesion Activity in Multiple Sclerosis through Central Vein Sign and Diffusion Tensor Imaging

Motivation: The central vein sign (CVS) is an emerging biomarker for distinguishing MS from other WM pathologies, reflecting perivenular inflammation typical of MS lesions. Goal(s): This study aims to characterize the pathophysiology of CVS-positive versus CVS-negative lesions using DTI. Approach: The analysis of four untreated RRMS patients over two months included FLAIR, T1, SWI, and DTI. Lesions were segmented on FLAIR and classified by SWI, with volumetric and DTI metrics analyzed. Results: CVS-positive lesions were larger, showed increased gadolinium enhancement, and had higher FA values, indicating greater inflammatory activity and structural alignment, while AD and RD values were similar across both lesion types. Impact: CVS presence in MS lesions significantly aids in distinguishing active, chronic lesions, enabling more precise monitoring of disease progression and management. This study highlights CVS's diagnostic value, warranting routine MRI inclusion in MS protocols.