MS lesions tend to form around tiny veins through which immune cells enter and attack brain tissue, so most lesions caused by MS have a vein in the middle. "We've known this for more than 100 years, but until recently we didn't have a way to see it on an MRI," Kaisey said.

Pascal Sati, PhDNew MRI techniques pioneered by Pascal Sati, PhD, director of the Neuroimaging Program in the Department of Neurology and associate professor of Neurology at Cedars-Sinai, make central vein sign visible.


"Current MRI images don't give us the whole picture, which is why we developed MRI sequences that improve image quality so that we can see very small veins, called veinules, in the brain," said Sati. "We superimpose that over a conventional MRI image of the lesions so that it is clear which brain lesions have a central vein and are likely caused by MS."

Ongoing studies at Cedars-Sinai and 10 other MS centers in North America are using Sati's technique to image 400 patients at risk of developing MS-the final step in scientifically validating central vein sign as a way to diagnose MS.

Importantly, the imaging technique Sati developed can be used with widely available MRI scanners and performed quickly enough to fit the workflow of the typical radiology center. He is also developing a machine learning algorithm to make evaluation of the imaging results easier for physicians.

"Once the image is taken, our deep learning algorithm can analyze it very quickly and tell the clinician how many lesions show the central vein sign," Sati said. "The number of lesions with the central vein sign can indicate whether or not the patient has MS."

The central vein sign could also help doctors determine how well a patient is responding to treatment by confirming that any new lesions that develop are caused by MS and not something else.

"With the central vein sign, we can clearly see which lesions are related to MS," Sati said. "This information is empowering doctors to make decisions about whether to continue a patient's current therapy, switch to a different MS therapy, or treat them for a completely new, or different, condition."

Another Window Into MS

Imaging of the retina-the layer of tissue at the back of the eye-and the optic nerve can also help improve MS diagnosis. Neurologist Omar Al-Louzi, MD, director of the Visual Outcomes Laboratory at Cedars-Sinai, is at the forefront of this technology.Omar Al-Louzi, MD

"Around 25% of MS patients experience vision loss or blurring as their first symptom, and as many as 80% experience vision problems at some point in the course of their disease," said Nancy Sicotte, MD, chair of the Department of Neurology, director of the Multiple Sclerosis and Neuroimmunology Program and Women's Guild Distinguished Chair in Neurology. "Dr. Al-Louzi's research seeks to use the eye as a window to produce better outcomes for patients."

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