Added diagnostic value of postcontrast susceptibility-weighted imaging with 1.5-Tesla magnetic resonance imaging for central vein sign assessment in multiple sclerosis

PURPOSE: This study aimed to assess whether post-contrast susceptibility-weighted imaging (SWI) at 1.5-T improves visualization of the central vein sign (CVS) in multiple sclerosis (MS) lesions. METHODS: In this prospective observational study, 30 patients with MS underwent 1.5-T brain magnetic resonance imaging (MRI), including pre-contrast SWI (SWI-C) and post-contrast SWI (SWI+C) sequences. Lesions were evaluated for location, contrast enhancement, and the presence of CVS and paramagnetic rim lesions (PRLs). Counts of CVS- and PRL-positive lesions were compared between SWI-C and SWI+C using the Wilcoxon signed-rank test, and the proportion of patients meeting the select-6 criterion was assessed with McNemar's test. Additional analyses using alternative thresholds (select-3 and > 50%) were performed to evaluate CVS positivity across different criteria. Correlations with Expanded Disability Status Scale (EDSS) scores were assessed using Spearman's rank correlation. No significant correlations were observed between EDSS, CVS, or PRL counts on either SWI-C or SWI+C. CONCLUSION: SWI+C at 1.5-T significantly enhances the detection of the CVS in MS lesions without substantially affecting PRL visualization, suggesting its practical value for routine clinical assessment of CVS. CLINICAL SIGNIFICANCE: SWI+C at 1.5-T, a widely accessible MRI field strength, enhances detection of the CVS in MS lesions, potentially improving diagnostic specificity in routine practice.