Central Vein Sign for Multiple Sclerosis: A Systematic Review and Meta-Analysis.

AIMS: To systematically review the diagnostic value of the central vein sign (CVS) in multiple sclerosis (MS) and to meta-analyse the proportion of positive lesions for CVS needed to distinguish MS from non-MS mimics. MATERIALS AND METHODS: Aliterature reviewwas performedand a proportionmeta-analysis wasperformed to examine the proportion of the CVS inMSlesions. Studies reporting a threshold of the CVS containing lesionswith 100% diagnostic accuracywere included in themeta-analysis. This was compared to MSmimics in order to establish the discriminative value of the CVS. RESULTS: The CVS was found to be viable at lower field strengths (3 T and 1.5 T) and automated analysis is currently less accurate than manual counting. Five studies were included for the proportional meta-analysis. From the analysis, a proportion of 45% of lesions having the CVS was suggested given that the findings that the weighted proportion was 46.4% (95% confidence interval [CI]: of 40.3%-52.6%) with low heterogeneity (I-2 = 0.0%; p=0.5). CONCLUSION: Although the CVS is a clinically relevant and viable sign, further work is needed to integrate this into the existing diagnostic criteria. As manual determination is a time-consuming process, the development of automated methods will be beneficial. With improvements in computational imaging techniques, the CVS will have an important role in the diagnosis and differentiation of MS. (C) 2020 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.