Incidental MRI anomalies suggestive of multiple sclerosis: The radiologically isolated syndrome
Abstract
Background The discovery and broad application of MRI in medicine has led to an increased awareness in the number of patients with incidental white matter pathology in the CNS. Routinely encountered in clinical practice, the natural history or evolution of such individuals with respect to their risk of developing multiple sclerosis (MS) is unclear. Objective To investigate the natural history of patients who exhibit incidental imaging findings highly suggestive of MS pathology. Methods Detailed clinical and radiologic data were obtained from asymptomatic patients with MRI anomalies suggestive of MS. Results The cohort consisted of 41 female and 3 male subjects (median age = 38.5, range: 16.2-67.1). Clinical evaluations were performed in 44 patients at the time of initial imaging; longitudinal clinical follow-up occurred for 30 patients, and longitudinal MRI data were acquired for 41 patients. Neurologic examination at the time of the initial MRI scans was normal in nearly all cases. While radiologic progression was identified in 59% of cases, only 10 patients converted to either clinically isolated syndrome or definite MS. The presence of contrast-enhancing lesions on the initial MRI was predictive of dissemination in time on repeat imaging of the brain (hazard ratio [HR] = 3.4, 95% confidence interval [1.3, 8.7], p = 0.01). Conclusion Individuals with MRI anomalies highly suggestive of demyelinating pathology, not better accounted for by another disease process, are very lik…
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Some individuals with MRI findings suggestive of inflammatory demyelination might potentially fulfil the 2024-revised McDonald criteria but not the currently established RIS criteria and therefore would not have been included in the present study.
“Lastly, some individuals with MRI findings suggestive of inflammatory demyelination might potentially fulfil the 2024-revised McDonald criteria but not the currently established RIS criteria and therefore would not have been included in the present study.”
From Applying the 2024-revised McDonald criteria for multiple sclerosis using conventional diagnostic tools: a single-centre prospective cohort study in Germany (2026) · cites this paper as [16]
RIS is uncommon; in Sweden, the incidence is 0.8 cases of RIS per 100,000 person-years compared to 10.2 cases of MS per 100,000 person-years.
“Data concerning the population-based incidence and prevalence of RIS are limited but suggest that RIS is uncommon (in Sweden, incidence of 0.8 cases of RIS per 100,000 person-years compared to 10.2 cases of MS per 100,000 personyears 84 )”
From Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria (2018) · cites this paper as [84]
The widespread use of MRI means incidental findings suggestive of MS are sometimes identified in some people who have no clinical symptoms; this is referred to as a radiologically isolated syndrome (RIS).
“The widespread use of MRI means incidental findings suggestive of MS are sometimes identified in some people who have no clinical symptoms.This is referred to as a radiologically isolated syndrome (RIS).28”
From Diagnosis of multiple sclerosis: progress and challenges (2017) · cites this paper as [28]
There are no accepted diagnostic criteria for RIS, but the Okuda 2009 criteria exist.
“There are no accepted diagnostic criteria for RIS, but the Okuda 2009 criteria 28”
From Diagnosis of multiple sclerosis: progress and challenges (2017) · cites this paper as [28]
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“This aligns with recent works that demonstrated that optic nerve lesions have significant diagnostic yield and improve early classification of MS. 22,29 Notably, in the present cohort, the second most influential factor was the consideration of asymptomatic individuals with RIS, where diagnosis was typically supported…”
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- Authors
- Okuda, D. T., Mowry, E. M., Beheshtian, A., Waubant, E., Baranzini, S. E., Goodin, D. S., Hauser, S. L., & Pelletier, D.
- Affiliations
- University of California, San Francisco (US)
- Venue
- Neurology
- Published
- 2009-03-03
- Volume
- 72
- Issue
- 9
- Pages
- 800-805
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- OpenAlex
- W2030113529
- Cited by
- 642
- References
- 2
- Citations by year
- 2026: 44 · 2025: 36 · 2024: 51 · 2023: 46 · 2022: 25 · 2021: 51 · 2020: 25 · 2019: 31 · 2018: 50 · 2017: 47 · 2016: 33 · 2015: 43 · 2014: 35 · 2013: 28 · 2012: 38
- FWCI
- 13.95
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Neurology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
- Health Sciences › Medicine › Oncology › Polyomavirus and related diseases
- Health Sciences › Medicine › Neurology › Peripheral Neuropathies and Disorders
- Keywords
- multiple sclerosis, incidental MRI findings, white matter lesions, demyelination, natural history (disease), clinically isolated syndrome, contrast-enhancing lesions, dissemination in time, radiographic progression, asymptomatic patients, risk prediction
- MeSH terms
- Adolescent, Adult, Aged, Brain, Demyelinating Diseases, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Multiple Sclerosis, Prospective Studies, Radiography, Radiology, Risk Factors, Syndrome, Cohort Studies, Young Adult
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