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Radiologically isolated syndrome: How could we accurately diagnose a subclinical period of multiple sclerosis?
Andreu Vilaseca1,2, Angela Vidal-Jordana1,2, Sofia Sceppacuercia3
1Neurology Department and Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari de Vall d'Hebron, Barcelona, Spain.
Background:
Radiologically isolated syndrome (RIS) represents a subclinical period of multiple sclerosis (MS).
Objectives:
We aimed to characterize and identify risk factors for developing MS in an RIS cohort and to assess various proposed RIS definitions for their predictive value in MS development.
Methods:
This cohort study included all patients with at least one typical inflammatory-demyelinating lesion suggestive of MS on brain and/or spinal cord magnetic resonance imaging (MRI). The development of MS symptoms and new T2 lesions were the primary and secondary outcomes, respectively. Cox regression was used to identify risk factors, and diagnostic performance was assessed.
Results:
Eighty-eight patients were included, with 25.0% developing MS symptoms over a mean 55.1-month follow-up. Younger age and spinal cord and cortico-/juxtacortical lesions were associated with worse outcomes. The 2017 McDonald dissemination in space (DIS) criteria and 2023 Lebrun RIS definition, which correspond to either the 2005 McDonald DIS criteria or one brain inflammatory-demyelinating lesion associated with two among oligoclonal bands, a spinal cord lesion and dissemination in time during radiological follow-up, showed high sensitivity (0.82 and 0.94, respectively). However, the sensitivity decreased (0.79) when only the baseline characteristics of the 2023 Lebrun RIS definition were considered. Combining the 2017 McDonald DIS criteria with positivity for oligoclonal bands or contrast-enhancing lesions on baseline MRI, which are the current McDonald MS criteria, improved the specificity (to 0.64 and 0.90, respectively).
Conclusions:
Our findings support the utility of the current DIS component of the 2017 McDonald MS criteria for RIS patients.
Insights
Radiologically isolated syndrome (RIS) patients have a 25% chance of developing multiple sclerosis (MS) within five years. Current diagnostic criteria, particularly dissemination in space, show promise for predicting MS development in RIS cohorts.
Area of Science:
- Neurology
- Radiology
- Immunology
Background:
- Radiologically isolated syndrome (RIS) is a preclinical stage of multiple sclerosis (MS).
- Identifying individuals at high risk of MS progression from RIS is crucial for timely intervention.
Purpose of the Study:
- To identify risk factors for MS development in a cohort of RIS patients.
- To evaluate the predictive accuracy of various RIS definitions for MS conversion.
Main Methods:
- A cohort study of 88 patients with MS-like lesions on MRI.
- Cox regression analysis to determine risk factors for MS development and new lesions.
- Assessment of diagnostic performance for different RIS criteria.
Main Results:
- 25% of RIS patients developed MS symptoms over a mean follow-up of 55.1 months.
- Younger age, spinal cord, and cortical lesions were associated with increased MS risk.
- The 2017 McDonald DIS criteria and 2023 Lebrun definition showed high sensitivity for predicting MS.
- Combining 2017 McDonald DIS criteria with baseline MRI findings improved specificity.
Conclusions:
- The dissemination in space (DIS) component of the 2017 McDonald MS criteria is valuable for managing RIS patients.
- Further refinement of RIS definitions may enhance prediction of MS development.
