[Radiologically isolated syndrome: multiple sclerosis based solely on MRI findings?]
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Updated: Jun 13, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
J Sellner1, L Schirmer, B Hemmer
1Neurologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland. sellner@lrz.tum.de
Abstract:
Incidental brain magnetic resonance imaging (MRI) findings are the result of an increasing usage of MRI in the diagnostic work-up of patients. An adequate assessment of patients in which brain lesions typical for multiple sclerosis (MS) are determined but who have been asymptomatic so far is problematic, especially when Barkhof-Tintoré criteria for spatial dissemination are fulfilled and no other differential diagnosis can be confirmed. This entity, the so-called radiologically isolated syndrome, constitutes a major diagnostic and therapeutic challenge. Two recent studies revealed that a subgroup of patients with radiologically isolated syndrome are at high risk for near-term development of MR-based progression and occurrence of the first clinical event. Hence, the radiologically isolated syndrome has to be classified as a possible preliminary phase of the clinical manifestation of MS in a subgroup of patients and entails in-depth therapeutic considerations. This article covers the current literature for this syndrome and, in the absence of official guidelines, provides a pragmatic diagnostic and therapeutic approach for patient management.
Insights
Radiologically isolated syndrome (RIS), identified incidentally on MRI scans, may precede clinical symptoms in a subset of patients. This finding necessitates careful management and therapeutic consideration for potential early multiple sclerosis (MS) development.
Area of Science:
- Neurology
- Radiology
- Neuroimmunology
Context:
- Increasing use of Magnetic Resonance Imaging (MRI) for diagnostic work-ups leads to more incidental findings.
- Identifying brain lesions typical for multiple sclerosis (MS) in asymptomatic patients presents diagnostic challenges, particularly when dissemination criteria are met without clear differential diagnoses.
Purpose:
- To review current literature on radiologically isolated syndrome (RIS).
- To provide a pragmatic diagnostic and therapeutic approach for managing patients with RIS in the absence of official guidelines.
Summary:
- Radiologically isolated syndrome (RIS) is characterized by MRI findings suggestive of MS in asymptomatic individuals.
- Recent studies indicate a subgroup of RIS patients face high risk for near-term MRI-based progression and clinical events.
- RIS may represent a preclinical phase of MS in some patients, warranting therapeutic discussion.
Impact:
- Highlights RIS as a significant diagnostic and therapeutic challenge in neurology.
- Informs clinical practice by offering a structured approach to managing patients with incidental MS-like findings on brain MRI.
- Emphasizes the need for further research and guideline development for RIS management.
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