BIOANALYSISPAPER
Nottingham's fast track pathway diagnosed 59 patients in 2.9 months on average, versus 5.6 under usual care, with no spinal taps and roughly 29% lower per patient cost.
A multiple sclerosis diagnosis can take months, and the path usually includes a spinal tap. A single UK clinic says it has reorganized the workup to skip both. A quality improvement project at Nottingham's MS center cut the average time to diagnosis from 5.6 months to 2.9 months and avoided the spinal tap entirely for every patient on its fast-track pathway.
The tool behind the change is the central vein sign, or CVS. It is a marker visible on a standard brain MRI: a small vein running through the center of a lesion, which helps separate MS from the long list of look-alike conditions, including small-vessel disease and migraine. CVS is not new. It was added to the McDonald criteria, the international checklist neurologists use to diagnose MS, in 2024, after years of studies showing it could confirm MS with high specificity. What is new is what happens when a clinic actually builds its referral pathway around it.
In a retrospective review of 59 consecutive patients referred between March 2024 and July 2025, the Nottingham team reported that the fast-track pathway delivered a diagnosis 83 days sooner on average than the usual outpatient route, a difference that reached statistical significance (Student t test, p = 0.003) in the study. No patient on the fast-track pathway received a lumbar puncture; the CVS-positive MRI was enough to close the case for the cohort studied.
Months of waiting for a result, then a hospital slot for a spinal tap, then more waiting, can mean starting disease-modifying therapy later than guidelines recommend. A CVS-confirmed MS diagnosis on the first scan can move that treatment decision forward by the same 83 days, plus whatever time the avoided spinal tap would have added.
Cost moved in the same direction. Mean per-patient spending was £707 on the fast-track pathway versus £999 under usual care, roughly a 29% reduction. At a recent GBP-to-USD rate of about 1.27, that works out to roughly $898 versus $1,269 per patient, a gap that compounds across a clinic's annual caseload. The authors flag the figure as a single-center estimate.
That last caveat is the one to hold onto. The design is a quality improvement project, not a randomized trial, and the cohort is 59 patients seen at one specialist NHS site with established MRI expertise. The fast-track pathway also bundles CVS with workflow changes such as triage and scheduling, so the 83-day saving and the elimination of spinal taps cannot be pinned on the marker alone.
The bottleneck is the workflow. CVS has been in the McDonald criteria since 2024 and remains underused in everyday practice, partly because reading the sign reliably requires training, and partly because reorganizing a referral pathway is harder than adopting a new imaging sequence. The Nottingham project is, in effect, a working draft of how a clinic closes that gap: who reads the scan first, who decides CVS is positive, how a patient moves from referral to answer without waiting on a slot for a spinal tap.
The next question is replication. The Nottingham team describes the pathway as reproducible, but the proof of that claim is whether other MS centers, including US sites where the cost numbers would land in a different reimbursement system, can run the same workup at the same scale. The marker is in the guideline. The workflow is not yet in the clinic.