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Updated: Jun 27, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Incidental MRI anomalies suggestive of multiple sclerosis: the radiologically isolated syndrome
D T Okuda1, E M Mowry, A Beheshtian
1Department of Neurology, University of California San Francisco, UCSF Multiple Sclerosis Center, San Francisco, CA 94117, USA. darin.okuda@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.
Insights
Patients with incidental MRI findings suggestive of multiple sclerosis (MS) often show radiologic progression. These individuals have a high likelihood of future clinical or radiologic events related to MS.
Area of Science:
- Neurology
- Radiology
- Neuroimmunology
Background:
- Magnetic Resonance Imaging (MRI) has increased incidental findings of white matter pathology in the central nervous system (CNS).
- The natural history and risk of developing multiple sclerosis (MS) in these patients remain unclear.
Purpose of the Study:
- To investigate the long-term outcomes of asymptomatic patients with incidental MRI findings suggestive of MS pathology.
Main Methods:
- Retrospective analysis of clinical and radiological data from asymptomatic patients with MRI anomalies suggestive of MS.
- Longitudinal follow-up of clinical status and serial MRI scans.
Main Results:
- 59% of patients showed radiologic progression, with 10 converting to clinically isolated syndrome or definite MS.
- Contrast-enhancing lesions on initial MRI predicted future dissemination in time (HR=3.4, p=0.01).
- Initial neurological examinations were normal in most cases.
Conclusions:
- Incidental MRI findings suggestive of demyelinating pathology carry a high risk of subsequent MS-related events.
- Further research is needed to fully characterize this risk.
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