BACKGROUND: Misdiagnosis is common in multiple sclerosis (MS) as a proportion of 
patients present with atypical clinical/magnetic resonance imaging (MRI) 
findings. The central vein sign has the potential to be a non-invasive, 
MS-specific biomarker.
OBJECTIVE: To test the accuracy of the central vein sign in predicting a 
diagnosis of MS in patients with diagnostic uncertainty at disease presentation 
using T2*-weighted, 3 T MRI.
METHODS: In this prospective pilot study, we recruited individuals with symptoms 
unusual for MS but with brain MRI consistent with the disease, and those with a 
typical clinical presentation of MS whose MRI did not suggest MS. We calculated 
the proportion of lesions with central veins for each patient and compared the 
results to the eventual clinical diagnoses. The optimal central vein threshold 
for diagnosis was established.
RESULTS: Thirty-eight patients were scanned, 35 of whom have received a clinical 
diagnosis. Median percentage of lesions with central veins was 51% in MS and 28% 
in non-MS. A threshold of 40.7% lesions with central veins resulted in 100% 
sensitivity and 73.9% specificity.
CONCLUSION: The central vein sign assessed with a clinically available T2* scan 
can successfully diagnose MS in cases of diagnostic uncertainty. The central 
vein sign should be considered as a diagnostic biomarker in MS.