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Updated: May 31, 2026
Safety Precautions and Operating Procedures in an (A)BSL-4 Laboratory: 4. Medical Imaging Procedures
Published on: October 3, 2016
The radiologically isolated syndrome: look (again) before you treat
Rebecca Spain1, Dennis Bourdette
1Department of Neurology, Oregon Health & Science University, Portland, USA. spainr@ohsu.edu
Abstract:
The advent and wide use of magnetic resonance brain imaging has led to in the unexpected detection of lesions that appear typical of multiple sclerosis (MS) in otherwise asymptomatic patients. Several cohorts of patients with the "radiologically isolated syndrome (RIS)" have been studied mainly retrospectively, and a proportion of them do go on to have clinical symptoms of MS. This has led to the not infrequent clinical conundrum of whether or not to treat patients with MRI lesions suggestive of MS, given the knowledge that MS disease-modifying therapies work best when given early in the disease course. However, the decision to proactively treat patients with RIS is countered by the increasing risks associated with MS disease-modifying therapies as well as the uncertain prognostic outcome of RIS. This review will highlight what is and is not known about the long-term outcomes of RIS and present recommendations for clinicians when faced with this challenging situation.
Insights
Radiologically isolated syndrome (RIS) involves detecting multiple sclerosis-like brain lesions in asymptomatic individuals. This review examines RIS outcomes and guides clinicians on treatment decisions for early multiple sclerosis intervention.
Area of Science:
- Neurology
- Neuroimaging
- Clinical Medicine
Background:
- Magnetic resonance imaging (MRI) advances reveal asymptomatic brain lesions.
- Radiologically isolated syndrome (RIS) is identified in patients without clinical symptoms.
Observation:
- A proportion of patients with RIS develop clinical symptoms of multiple sclerosis (MS).
- Early MS treatment is most effective, creating a treatment dilemma for RIS patients.
Findings:
- The long-term outcomes of RIS remain incompletely understood.
- Balancing early MS treatment benefits against therapy risks and uncertain prognosis is crucial.
Implications:
- This review provides insights into RIS prognosis and clinical management.
- Recommendations are offered for clinicians managing patients with incidental MS-like lesions.
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