We aimed to evaluate the pooled incidence of central vein sign on T2*-weighted 
images from patients with multiple sclerosis (MS), and to determine the 
diagnostic performance of this central vein sign for differentiating MS from 
other white matter lesions and provide an optimal cut-off value. A computerized 
systematic search of the literature in PUBMED and EMBASE was conducted up to 
December 14, 2018. Original articles investigating central vein sign on 
T2*-weighted images of patients with MS were selected. The pooled incidence was 
obtained using random-effects model. The pooled sensitivity and specificity were 
obtained using a bivariate random-effects model. An optimal cut-off value for 
the proportion of lesions with a central vein sign was calculated from those 
studies providing individual patient data. Twenty-one eligible articles covering 
501 patients with MS were included. The pooled incidence of central vein sign at 
the level of individual lesion in patients with MS was 74% (95% CI, 65-82%). The 
pooled sensitivity and pooled specificity for the diagnostic performance of the 
central vein sign were 98% (95% CI, 92-100%) and 97% (95% CI, 91-99%), 
respectively. The area under the HSROC curve was 1.00 (95% CI, 0.99-1.00). The 
optimal cut-off value for the proportion of lesions with a central vein sign was 
found to be 45%. Although various T2*-weighted images have been used across 
studies, the current evidence supports the use of the central vein sign on 
T2*-weighted images to differentiate MS from other white matter lesions.