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Objective  The diagnosis of multiple sclerosis ( MS ) presently relies on radiographic assessments of imperfect specificity. Recent data using T2* methodology for the detection of the “central vessel sign” ( CVS ) in  MS  lesions suggests this novel  MRI  technique may distinguish  MS  from other disorders. Our aim was to determine if evaluation for  CVS  on 3T  FLAIR *  MRI  differentiates  MS  from migraine.    Methods  Patients with  MS  or migraine and a prior brain  MRI  demonstrating at least two hyperintense lesions ≥3 mm were recruited. Exclusion criteria included any additional comorbidity known to cause brain  MRI  abnormalities. 3T  MRI  was performed in each participant with administration of gadopentetate dimeglumine, and  FLAIR * images were generated in postprocessing. The total number of discrete ovoid lesions ≥3 mm were counted on  FLAIR , per participant, and subsequently evaluated for presence of  CVS  on  FLAIR *. An exploratory method evaluating for  CVS  in a maximum of 12 lesions per subject was also completed.    Results  Ten participants with  MS  and 10 with migraine completed the study. The median percentage (quartiles) of lesions in  MS  participants with  CVS  was 84 (79, 94) compared to 22 (15, 54) in migraine ( P  = 0.008). In a subanalysis by brain region, in the subcortical and deep white matter, the median percentage (quartiles) of lesions in  MS  participants with  CVS  was 88 (81, 100) compared to 19 (11, 54) in migraine ( P  = 0.004). This difference was not identified in juxtacortical, periventricular, or infratentorial regions.    Interpretation  Identification of  CVS  using  FLAIR * on 3T  MRI  helps differentiate  MS  from migraine, particularly in the subcortical and deep white matter.

“Central vessel sign” on 3T FLAIR * MRI for the differentiation of multiple sclerosis from migraine