Venocentric Lesions on MRI: An Early Marker of MS?

Venocentric lesions seen on magnetic resonance imaging (MRI) may be associated with future risk of developing multiple sclerosis, according to a new article that reviewed studies of that diagnostic technique (Quinn et al., 2013).

The review article was authored by Matthew P. Quinn and colleagues from Western University in London, Canada. It appeared in the July edition of Frontiers in Neurology.

The authors pointed out that during the past decade, researchers have been exploring MRI-detectable veins seen in areas of white matter hyperintensities (WMH) as possible markers for later development of MS. "This biomarker is well established as detectable at 3 and 7 T, and efforts should be made to identify/optimize clinically practical methods for its evaluation," they wrote.

Studies have shown that these penetrating veins can be detected in most MS lesions using T2-weighted or susceptibility-weighted imaging. Even so, the specificity of this potential biomarker hasn't been thoroughly assessed, the authors said.  

In research over the past few years, investigators have noted that results in microangiopathic lesions are inconsistent. However, that is not the case with asymptomatic WMHs and neuromyelitis optica. In both of those clinical presentations, penetrating lesions are less frequently seen than in plaques associated with MS.

"Prospective studies have shown that the presence of venocentric lesions at an early clinical presentation is highly predictive of future MS diagnosis," the authors wrote. 

They noted that although the recognition of that difference holds promise, considerable work needs to be done in order to use this potential tool to distinguish between MS and other clinical conditions that may mimic MS, such as acute disseminated encephalomyelitis.

In addition, several technical challenges need to be addressed. One is how to proceed in patients with very few lesions. What is the minimum number of lesions that must be assessed to obtain a reliable evaluation? On the other hand, in patients with many lesions, would it be necessary to rate all the lesions, or could a competent assessment be made by rating only a subset? 

Still another challenge would be to agree on what, precisely, constitutes a penetrating vein from a radiological point of view. 

"Work remains to be done to confirm or exclude lesions of common MS mimics as venocentric," the authors concluded. "Common imaging practice and lesion-rating paradigms should be adopted by scientists working in this field." 

Key open questions

• What special considerations should be given in evaluating patients with very few or with many lesions?
• From a radiologic standpoint, what, exactly, constitutes a penetrating vein?

Disclosures

Mr. Quinn and coauthor Ravi S. Menon, Ph.D., report no conflicts of interest. A third coauthor, Marcelo Kremenchutzky, M.D., or his institution received research support from the MS Society of Canada, Bayer, Biogen Idec, Genzyme, Serono, Teva Neuroscience, Sanofi, and Novartis.