MS diagnosis without a needle: the MRI test that finds the "central vein"
Nottingham doctors now diagnose MS without a lumbar puncture, using an MRI scan just six minutes longer. How it works and what it means for patients.
Imagine a neurologist telling you: "We suspect multiple sclerosis. To be sure, we need a lumbar puncture." A needle in your back, a day in hospital, and often a headache afterwards. When I was diagnosed, that was the standard route. That is why the news from Nottingham genuinely made me happy.
On 6 October 2026 the BBC reported that doctors in Nottingham, UK, can now diagnose MS without a needle, using a special type of MRI scan [1](#ref-1). The test is the result of more than 20 years of work at the University of Nottingham and is being used at Queen's Medical Centre.
> In short: the test looks for the central vein sign — a tiny vein in the middle of an MS lesion. It adds about six minutes to a normal MRI scan and can be done on a standard scanner.
What exactly was discovered
MS leaves scars (lesions) in the brain and spinal cord. The problem is that white spots on MRI also appear in people with migraine, high blood pressure, diabetes, or simply with age. So doctors often want extra proof, usually oligoclonal bands in spinal fluid, which requires a [lumbar puncture](/en/blog/what-doctors-look-mri-scans-multiple-sclerosis-detailed-guide).
Professor Paul Morgan's team used a 7 Tesla MRI scanner, the most powerful of its kind at the time, installed more than ten years ago. When they "cranked up the magnification", they saw a small dark dot in the middle of MS lesions. They later realised it was a vein running through the lesion [1](#ref-1). MS inflammation develops around small veins. Lesions from other conditions usually don't look like that.
Early Nottingham studies showed this sign appears in the large majority of MS lesions but rarely in lesions caused by ageing or small-vessel disease [3](#ref-3) [4](#ref-4). Later work showed it also works on more common 3 Tesla scanners [5](#ref-5). That is the key: something that only works on a rare research scanner can't help most patients.
What doctors and patients say
Dr Chris Gilmartin, a neurologist at Queen's Medical Centre, says a lumbar puncture "involves a day trip to hospital and can cause headaches and back pain", and patients didn't like it. "When people are being diagnosed with MS it's clearly a very stressful time," he told the BBC [1](#ref-1).
Teresa Needham from Stapleford was first checked for a suspected stroke because of facial paralysis affecting her lip. It turned out to be MS. She dislikes needles, so she chose the MRI. "I was able to go to that test and go to work straight after," she said [1](#ref-1). I recognise that feeling. When your world is falling apart, every bit of stress you are spared matters.
Is this officially recognised?
Yes, and this is the most important part of the story. The central vein sign was added to the 2024 revision of the McDonald criteria, published in 2025 [2](#ref-2). In certain situations the criteria now allow MS to be diagnosed when veins inside lesions take the place of spinal-fluid evidence. A common rule is "select six": if at least six lesions show a central vein (or most of them, when there are few), that strongly supports MS.
The international NAIMS group described how to measure the sign back in 2016 [6](#ref-6). The large US CAVS-MS study later confirmed that the test reliably separates MS from other conditions in everyday practice [7](#ref-7).
What this does NOT mean
It doesn't mean the lumbar puncture disappears. It still helps when the picture is unclear, when infections or other diseases must be ruled out, or when MRI shows too few lesions. Nor is the test available everywhere. It needs special scan sequences (SWI or T2*), trained radiologists and scanner time. Even in the UK it isn't used everywhere yet; the Nottingham team is working on a national rollout [1](#ref-1).
MRI isn't magic either. The central vein sign is one piece of evidence; a neurologist still makes the diagnosis based on symptoms, examination and all results. I've written more about [early MS symptoms](/en/simptomi) and [coming to terms with a diagnosis](/en/blog/you-just-heard-have-ms-guide-through-first-weeks).
And in Serbia and the region?
In Serbia, diagnosis today mostly relies on MRI, examination and, when needed, lumbar puncture. Some centres already use SWI sequences. If your neurologist suggests a puncture, feel free to ask: "Could central vein imaging help in my case?" It isn't a demand, it's a conversation. The answer depends on your results and the hospital's equipment.
This is a good example of how science really changes lives: no spectacular drug, just six extra minutes in the scanner, and one fewer needle for someone who has just heard the hardest words of their life.
This article is informational and does not replace advice from a neurologist. Don't refuse recommended tests without talking to your doctor.