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ARTICLES: D. T. Okuda, E. M. Mowry, A. Beheshtian, E. Waubant, S. E. Baranzini, D. S. Goodin, S. L. Hauser, and D. Pelletier Incidental MRI anomalies suggestive of multiple sclerosis: The radiologically isolated syndrome Neurology 2009; 72: 800-805 [Abstract] [Full text] [PDF]

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Incidental MRI anomalies suggestive of multiple sclerosis: The radiologically isolated syndrome

Fraser Moore   (6 May 2009)

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Darin T. Okuda   (6 May 2009)

Incidental MRI anomalies suggestive of multiple sclerosis: The radiologically isolated syndrome 6 May 2009
Fraser Moore, McGill University 3755 Cote-Ste-Catherine, E-005, Montreal QC H3T 1E2 Send Correspondence to journal: Re: Incidental MRI anomalies suggestive of multiple sclerosis: The radiologically isolated syndrome fraser.moore{at}mcgill.ca Fraser Moore	Most neurologists have seen patients referred to them for incidentally-detected white matter abnormalities on MRI and the possibility of MS. Okuda et al. present a cohort of 44 of these cases with longitudinal follow-up, which provides some data on the prognosis of such individuals. [1] The authors do not provide information on how the patients were selected. Were they identified retrospectively after review of neurology office records or radiology reports? Do they represent a consecutive series of such patients and, if so, over what time period? The authors also state that they excluded individuals with MRI features of leukoaraiosis or extensive white matter changes lacking clear involvement of the corpus callosum. Did the authors have more detailed criteria that they used to define these individuals or was this simply a question of their judgment? Finally, it would also be interesting to know how many individuals were excluded and if they were older. Clarification of these questions will help clinicians judge the relevancy of the results. Reference 1. Okuda DT, Mowry EM, Beheshtian A et al. Incidental MRI anomalies suggestive of multiple sclerosis: The radiologically isolated syndrome. Neurology 2009;72:800-805. Disclosure: The author reports no disclosures.
Reply from the author 6 May 2009
Darin T. Okuda, University of California, San Francisco, UCSF Multiple Sclerosis Center 350 Parnassus Avenue, Suite 908, San Francisco, CA 94117 Send Correspondence to journal: Re: Reply from the author darin.okuda{at}ucsf.edu Darin T. Okuda	We thank Dr. Moore for his interest in our research. The cases in our article were ascertained through requested consultations by referring neurologists in the community. In addition, patients were identified within our collective practice at the UCSF Multiple Sclerosis (MS) Center. [1] The published cases represent a consecutive series of subjects first identified in 2004. Those who met investigational criteria after a comprehensive review of existing medical and imaging records, historical data, and neurological examinations were included in the analysis. Radiological reports were not used as a retrospective screen to identify potential cases. However, incidentally identified structural neuro-imaging anomalies were subsequently verified by at least two MS specialists during the initial consultation. Additional selection criteria not highlighted within our publication were not utilized. We excluded one case, a 54-year-old woman that exhibited a pattern of leukoaraiosis on brain MRI whose diagnosis was more consistent with chronic microvascular disease. The proposed criteria for the radiologically isolated syndrome (RIS) provided an operational definition that could be applied within the neurological community. As with existing criteria for disease entities within and beyond the neurosciences, clinician judgment is necessary for cases that may be less clear in their delineation. We hope that future data generated from our prospectively followed RIS cohort at the UCSF MS Center will define the prognostic significance of clinical and molecular markers, along with other radiological markers of disease progression. Understanding the natural course and evolution of RIS will assist with the clinical management of patients in daily practice and ultimately all patients with MS. Disclosure: The author reports no disclosures.