{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T01:51:35Z","timestamp":1793325095919,"version":"4.5.0"},"reference-count":37,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Neurol"],"published-print":{"date-parts":[[2024,2,1]]},"abstract":"<jats:sec id=\"ab-noi230089-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Multiple sclerosis (MS) misdiagnosis remains an important issue in clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi230089-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To quantify the performance of cortical lesions (CLs) and central vein sign (CVS) in distinguishing MS from other conditions showing brain lesions on magnetic resonance imaging (MRI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi230089-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This was a retrospective, cross-sectional multicenter study, with clinical and MRI data acquired between January 2010 and May 2020. Centralized MRI analysis was conducted between July 2020 and December 2022 by 2 raters blinded to participants\u2019 diagnosis. Participants were recruited from 14 European centers and from a multicenter pan-European cohort. Eligible participants had a diagnosis of MS, clinically isolated syndrome (CIS), or non-MS conditions; availability of a brain 3-T MRI scan with at least 1 sequence suitable for CL and CVS assessment; presence of T2-hyperintense white matter lesions (WMLs). A total of 1051 individuals were included with either MS\/CIS (n\u2009=\u2009599; 386 [64.4%] female; mean [SD] age, 41.5 [12.3] years) or non-MS conditions (including other neuroinflammatory disorders, cerebrovascular disease, migraine, and incidental WMLs in healthy control individuals; n\u2009=\u2009452; 302 [66.8%] female; mean [SD] age, 49.2 [14.5] years). Five individuals were excluded due to missing clinical or demographic information (n\u2009=\u20093) or unclear diagnosis (n\u2009=\u20092).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi230089-7\">\n                    <jats:title>Exposures<\/jats:title>\n                    <jats:p>MS\/CIS vs non-MS conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi230089-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Area under the receiver operating characteristic curves (AUCs) were used to explore the diagnostic performance of CLs and the CVS in isolation and in combination; sensitivity, specificity, and accuracy were calculated for various cutoffs. The diagnostic importance of CLs and CVS compared to conventional MRI features (ie, presence of infratentorial, periventricular, and juxtacortical WMLs) was ranked with a random forest model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi230089-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The presence of CLs and the previously proposed 40% CVS rule had a sensitivity, specificity, and accuracy for MS of 59.0% (95% CI, 55.1-62.8), 93.6% (95% CI, 91.4-95.6), and 73.9% (95% CI, 71.6-76.3) and 78.7% (95% CI, 75.5-82.0), 86.0% (95% CI, 82.1-89.5), and 81.5% (95% CI, 78.9-83.7), respectively. The diagnostic performance of the CVS (AUC, 0.89 [95% CI, 0.86-0.91]) was superior to that of CLs (AUC, 0.77 [95% CI, 0.75-0.80];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001), and was increased when combining the 2 imaging markers (AUC, 0.92 [95% CI, 0.90-0.94];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.04); in the random forest model, both CVS and CLs outperformed the presence of infratentorial, periventricular, and juxtacortical WMLs in supporting MS differential diagnosis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi230089-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>The findings in this study suggest that CVS and CLs may be valuable tools to increase the accuracy of MS diagnosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamaneurol.2023.4737","type":"journal-article","created":{"date-parts":[[2023,12,11]],"date-time":"2023-12-11T11:01:56Z","timestamp":1702292516000},"page":"143","source":"Crossref","is-referenced-by-count":66,"title":["Diagnostic Performance of Cortical Lesions and the Central Vein Sign in Multiple Sclerosis"],"prefix":"10.1001","volume":"81","author":[{"given":"Alessandro","family":"Cagol","sequence":"first","affiliation":[{"name":"Translational Imaging in Neurology Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland"},{"name":"Department of Neurology, University Hospital Basel, Switzerland"},{"name":"Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel and University of Basel, Basel, Switzerland"},{"name":"Department of Health Sciences, University of Genova, Genova, 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