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This Article Figures Only Full Text Full Text (PDF) CME: Take the course for this article: Volume 72, Number 9, March 3, 2009 Podcast Korean Translation JapaneseTranslation Correction (v72,p1284) All Versions of this Article: 01.wnl.0000335764.14513.1av1 72/9/800    most recent Correspondence: Submit a response Correspondence: View responses Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Okuda, D. T. Articles by Pelletier, D. Search for Related Content PubMed PubMed Citation Articles by Okuda, D. T. Articles by Pelletier, D. Related Collections MRI Autoimmune diseases Multiple sclerosis Related Article

Incidental MRI anomalies suggestive of multiple sclerosis

The radiologically isolated syndrome

From the University of California, San Francisco, Department of Neurology, UCSF Multiple Sclerosis Center.

Address correspondence and reprint requests to Dr. Darin T. Okuda, University of California, San Francisco, Department of Neurology, UCSF Multiple Sclerosis Center, 350 Parnassus Avenue, Suite 908, San Francisco, CA 94117 darin.okuda{at}ucsf.edu

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 likely to experience subsequent radiologic or clinical events related to multiple sclerosis. Additional studies will be necessary to fully define this risk.

Abbreviations: CI = confidence interval; CIS = clinically isolated syndrome; EDSS = Expanded Disability Status Scale; FLAIR = fluid-attenuated inversion recovery; HR = hazard ratio; MS = multiple sclerosis; ONTT = Optic Neuritis Treatment Trial; RIS = radiologically isolated syndrome.

Editorial, page 780

e-Pub ahead of print on December 10, 2008, at www.neurology.org.

Disclosure: The authors report no disclosures.

Received June 17, 2008. Accepted in final form August 19, 2008.

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The radiologically isolated syndrome: Is it very early multiple sclerosis?

Dennis Bourdette and Jack Simon
Neurology 2009 72: 780-781. [Full Text] [PDF]

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