Goodbye, Needles and Spinal Taps? New Imaging Test Detects Multiple Sclerosis in Minutes

A new study shows that an MRI scan may be as effective as a spinal tap in diagnosing multiple sclerosis in the early stages of the disease. The scan looks for a sign called a “central vein” within lesions in the brain, which is common in MS. In addition to being more accurate, this method is more comfortable for the patient and can avoid the side effects of the puncture. This could help in a faster and safer diagnosis of the disease.

Multiple sclerosis (MS) is a chronic, autoimmune neurological disease that affects the central nervous system, mainly the brain and spinal cord. In MS, the immune system attacks myelin, a protective layer that surrounds nerves, causing inflammation and tissue damage.

This interferes with the nerves’ ability to transmit signals correctly, leading to a wide range of symptoms, including weakness, fatigue, loss of balance, blurred vision and cognitive difficulties. One of the biggest challenges with MS is that it can manifest in so many different ways, which makes early diagnosis difficult. Furthermore, there is no single definitive test that confirms the disease.

Because of these difficulties, it is common for patients to go months or even years between the first symptoms and the final diagnosis. This delay can harm treatment, because the sooner the disease is treated, the greater the chances of preserving neurological functions and avoiding permanent disabilities.

However, early diagnosis also carries risks, such as making mistakes, since other diseases can cause similar symptoms. Therefore, finding more accurate and less invasive methods to diagnose multiple sclerosis is a priority.

A common test in the diagnostic process is the analysis of cerebrospinal fluid (CSF), which involves collecting this fluid through a lumbar puncture, a procedure performed on the back. In this fluid, doctors look for oligoclonal bands (OLBs), proteins associated with inflammation of the nervous system.

If the bands are present in the CSF but not in the blood, this may indicate multiple sclerosis. However, these bands can also appear in other inflammatory and infectious diseases, which limits its specificity.

In addition, a lumbar puncture can be uncomfortable and cause side effects such as severe headaches and the need for hospitalization, which generates extra costs and time away from daily activities.

In light of this, researchers have been seeking safer and more effective alternatives, such as the use of magnetic resonance imaging (MRI) focusing on a specific sign called the central vein sign (CVS).

This sign appears when there is a visible vein in the center of a lesion in the brain, something very common in lesions caused by multiple sclerosis. The presence of this sign has proven to be a reliable indicator for differentiating multiple sclerosis from other diseases that also affect the central nervous system.

Example of multiple sclerosis lesions with a central vein. On the left, the orange arrows show multiple sclerosis lesions (white marks) and on the right, the corresponding section of the image showing that each lesion has a central vein (in the form of a ring in the same location as the lesion).

Initially, studies used a criterion of 40% of lesions presenting the central vein, but later a simpler version emerged: the "rule of 6", which establishes that finding 6 lesions with this signal on an MRI is enough to support the diagnosis of multiple sclerosis.

In this study conducted in the United Kingdom, researchers compared the effectiveness of using MRI with the central vein signal versus lumbar puncture with analysis of oligoclonal bands in patients who presented clinically isolated syndrome (CIS), a first manifestation suggestive of multiple sclerosis.

A total of 113 people were recruited, of whom 99 completed all stages. After 18 months of follow-up, 80 of them were diagnosed with multiple sclerosis.

The results showed that MRI with assessment of the central vein signal was as effective as lumbar puncture: sensitivity (ability to correctly identify cases of multiple sclerosis) was 90% for the central vein signal (using the criterion of 40% lesions) and 84% for oligoclonal bands. The "rule of 6" was even slightly more sensitive, at 91%.

Another important finding was regarding side effects: 75% of patients had some side effect after lumbar puncture, while only 9% reported any side effects after MRI. Furthermore, all participants preferred MRI to lumbar puncture as a diagnostic method.

In conclusion, this study demonstrated that MRI with evaluation of the central vein signal is as effective as analysis of cerebrospinal fluid by lumbar puncture for diagnosing multiple sclerosis in patients with typical initial symptoms.

The imaging technique is more comfortable for patients and may become a promising alternative in future diagnostic criteria for multiple sclerosis. However, larger studies are still needed to confirm the effectiveness of the central vein signal in less typical cases and outside specialized centers.

READ MORE:

Comparison of the Diagnostic Performance of the Central Vein Sign and CSF Oligoclonal Bands Supporting the Diagnosis of Multiple Sclerosis

Christopher Martin Allen, Margareta A. Clarke, Hari V. Pai, 

Marija Cauchi, Jonathan Hawken, Zin M. Htet, Kimberley Allen-Philbey, 

Bader Mohamed, Deborah Fitzsimmons, Roshan Das Nair, Paul Morgan, 

Christopher Partlett, Rob A. Dineen, Klaus Schmierer, Emma Clare Tallantyre, and, Nikos Evangelou 

Neurology. June 2025 issue 1 (2)

https://doi.org/10.1212/WN9.0000000000000017

Abstract:

The central vein sign (CVS) describes the presence of venules within multiple sclerosis (MS) brain lesions, visible on T2*-weighted MRI. In the upcoming revision of the MS diagnostic criteria, the simplified “rule of 6” (i.e., finding 6 lesions with a central venule) can support the diagnosis of MS as an alternative to lumbar puncture (LP). We evaluated whether a T2*-weighted MRI scan is more sensitive than oligoclonal bands (OCBs) for diagnosing MS at presentation with a typical clinically isolated syndrome (CIS). We also compared the tolerability of LP and the additional MRI. Participants requiring an LP to meet the 2017 McDonald diagnostic criteria for MS were enrolled in this multicenter, prospective, diagnostic superiority study from 3 UK neuroscience centers. A six-minute T2*-weighted sequence was used to assess the CVS using 2 definitions: a 40% threshold of all eligible lesions and the rule of 6. These were compared with OCBs, using the clinical diagnosis at 18 months as the reference standard. Of 113 participants, 99 (mean age: 38, female: 73%) have completed all study activities: 80 were diagnosed with MS, 10 remained CIS, 8 had alternative diagnoses, and 1 remained without a diagnosis. No significant difference in diagnostic sensitivity was detected between 40% CVS threshold (90% [CI 81%–96%]) and OCB testing (84% [CI 74%–91%]) (p = 0.332). The rule of 6 had a sensitivity of 91% (CI 83%–96%). Side effects were reported by 75% following LP compared with 9% following MRI. All participants preferred their MRI scan over their LP. CVS and OCB testing is equally sensitive in supporting the diagnosis of MS in cases of typical CIS. CVS assessed using the 40% threshold, and the simpler rule of 6 produces equivalent diagnostic performance. Compared with OCB testing, CVS testing seems safer and better tolerated by patients. Further studies are needed to evaluate CVS specificity, particularly outside of typical CIS cases, as studied here. This study provides Class IV evidence that CSF OCBs and the CVS are equally sensitive in supporting a diagnosis of MS in patients presenting with CIS.