A Faster Way to Diagnose Multiple Sclerosis: The Central Vein Sign in Routine Clinical Practice.
The central vein sign (CVS) was included in 2024 McDonald criteria but remains underutilized in clinical practice. Implementation of CVS may reduce the requirement for lumbar punctures (LPs). At Nottingham, UK academic multiple sclerosis (MS) center, we implemented a fast-track (FT) pathway incorporating CVS analysis for people referred with imaging suggestive of MS as part of a quality improvement project. We retrospectively reviewed consecutive patients diagnosed with MS referred between March 1, 2024, and July 31, 2025.
Data from 59 consecutive patients were analyzed. The mean time to diagnosis was 2.9 months in FT pathway and 5.6 months in usual outpatient pathway (Student t test mean 83-day difference, p = 0.003). No people with MS in FT pathway received a LP. The mean cost per patient was £707 (FT) vs £999 (outpatient).
Routine application of CVS within a structured diagnostic pathway accelerated diagnosis, eliminated LPs, and reduced costs. Our findings support a broader adoption of CVS to streamline MS workup.
Data from 59 consecutive patients were analyzed. The mean time to diagnosis was 2.9 months in FT pathway and 5.6 months in usual outpatient pathway (Student t test mean 83-day difference, p = 0.003). No people with MS in FT pathway received a LP. The mean cost per patient was £707 (FT) vs £999 (outpatient).
Routine application of CVS within a structured diagnostic pathway accelerated diagnosis, eliminated LPs, and reduced costs. Our findings support a broader adoption of CVS to streamline MS workup.
Authors
Gilmartin Gilmartin, Paskin Paskin, Clarke Clarke, De Dios Peréz De Dios Peréz, Morgan Morgan, Dineen Dineen, Evangelou Evangelou
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