Background There is no absolute biomarker for the diagnosis of multiple sclerosis (MS). White matter lesion (WML) central veins detected using T2* weighted imaging is proving promising.

Objectives To confirm if the proportion of WMLs with central veins can predict the clinical diagnosis in a cohort of patients with diagnostic uncertainty of MS.

Methods Patients had a 3T T2* weighted MRI scan and then followed up by their neurologists until a diagnosis was confirmed. The T2* scan was reviewed by a rater blinded to all clinical data and a radiological diagnosis of MS or non-MS made, based purely on the proportion of WMLs with central veins (≥40%=MS). A simpler diagnostic rule of identifying 6 WMLs with central veins for a diagnosis of MS was also employed.

Results Of the 22 patients scanned to date, 10 patients have received a clinical diagnosis. Two of three patients who were diagnosed with MS had more than 40% of WMLs with central veins. The remaining 7 patients who were diagnosed as non-MS had less than 40% of WMLs with central veins. 9/10 MRI diagnoses appear to be correct. Identifying a subset of 6 WMLs with central veins led to 8/10 correct diagnoses.

Conclusions WML central veins appear to be of value in the diagnostic process for MS when other tests fail at initial presentation.