BACKGROUND AND PURPOSE: Previous T2*-weighted magnetic resonance imaging (MRI) 
studies have used white matter lesion (WML) central veins to distinguish 
multiple sclerosis (MS) from its mimics. To be clinically applicable, the 
"central vein sign" needs to be detectable across different T2* sequences. Our 
objective was to determine if the central vein sign is reliably present in MS 
and absent in patients with ischemic small vessel disease (SVD) across different 
T2* sequences at 3T MRI.
METHODS: Ten patients with MS and 10 with SVD were each scanned on a 3 T Philips 
and GE scanner. The MRI protocol included 3-dimensional (3D) T2* GRE, T2* with 
high echo planar imaging (EPI) factor and susceptibility-weighted angiography 
(SWAN). Total WML numbers, central vein numbers, and proportion of WMLs with 
central veins were calculated using each sequence. Three blinded raters 
identified a subset of six WMLs with central veins to diagnose MS or SVD.
RESULTS: Irrespective of the sequence, MS patients were identified based on a 
higher proportion of WMLs with central veins. This proportion was dependent on 
the T2* sequence used. T2* with high EPI allowed the highest median proportion 
(69.6%) in MS patients; 6.1% in SVD patients (P < .0004). Rater reproducibility 
varied depending on the T2* sequence used. T2* with high EPI produced good 
agreement with the clinical diagnosis (Cohen's kappa range; .78-.89), as did 
SWAN imaging with some raters; ĸ = .69.
CONCLUSIONS: The central vein sign can diagnose MS in the clinical setting of 
modern 3T scanners. However, variations in the T2* sequences need to be 
considered when defining a threshold for diagnosis.