Limits...
Radiologically isolated syndrome: an uncommon finding at a university clinic in a high-prevalence region for multiple sclerosis.

Granberg T, Martola J, Aspelin P, Kristoffersen-Wiberg M, Fredrikson S - BMJ Open (2013)

Bottom Line: The improved availability of MRI in medicine has led to an increase in incidental findings.RIS, according to present criteria, is an uncommon finding in a tertiary hospital setting in a high-prevalence region for MS where awareness and clinical suspicion of MS is common.In order to study the prognosis of RIS, multicentre studies, or case-control studies are recommended.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.

ABSTRACT

Objective: The improved availability of MRI in medicine has led to an increase in incidental findings. Unexpected brain MRI findings suggestive of multiple sclerosis (MS) without typical symptoms of MS were recently defined as radiologically isolated syndrome (RIS). The prevalence of RIS is uncertain. The aim of this study was to determine the prevalence of RIS at a university hospital in a region with a high prevalence for MS and describe the long-term prognosis of the identified patients.

Design: Retrospective cohort study conducted in 2012.

Setting: All brain MRI examinations performed at Karolinska University Hospital in Huddinge, Stockholm, Sweden during 2001 were retrospectively screened by a single rater for findings fulfilling the Okuda criteria. The sample year was chosen in order to establish the long-term prognosis of the patients identified. The examinations of interest were re-evaluated according to the Barkhof criteria by a neuroradiologist with long experience in MS.

Participants: In total 2105 individuals were included in the study. Ages ranged from 0 to 90 years with a median age of 48 years. Only one patient with RIS was identified, equivalent to a prevalence of 0.05% in the studied population, or 0.15% among patients aged 15-40 years. The patient with RIS developed symptoms consistent with MS within 3 months accompanied with radiological progression and was diagnosed with MS.

Conclusions: RIS, according to present criteria, is an uncommon finding in a tertiary hospital setting in a high-prevalence region for MS where awareness and clinical suspicion of MS is common. In order to study the prognosis of RIS, multicentre studies, or case-control studies are recommended.

No MeSH data available.


Related in: MedlinePlus

Axial fluid attenuated inversion recovery images of the identified radiologically isolated syndrome patient illustrating the multiple T2 hyperintensities and the contrast-enhancing lesion in the far right image.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3822304&req=5

BMJOPEN2013003531F2: Axial fluid attenuated inversion recovery images of the identified radiologically isolated syndrome patient illustrating the multiple T2 hyperintensities and the contrast-enhancing lesion in the far right image.

Mentions: The patient with RIS was a 43-year-old woman without any neurological symptoms or any history of neurological disorders except for migraine since more than 10 years. A neurological examination did not reveal any pathological findings. She had good effect of triptanes. Owing to her long history of migraine and still frequent attacks she was referred for MRI of the brain in February 2001. The scan showed 15 supratentorial T2 lesions, of which 12 were periventricular and 2 were juxtacortical. Gadolinium-enhanced sequences showed enhancement in one of the lesions. Thus three of the four of the Barkhof criteria were fulfilled.31 Images obtained from this patient can be seen in figure 2. Owing to the MRI findings, she was referred to a neurologist in March where a second neurological examination was normal. Cerebrospinal fluid analysis revealed oligoclonal bands and an elevated IgG index. In May she returned to the neurological clinic due to a sudden onset of intermittent bilateral symptoms in arms and hands. A new neurological examination revealed bilateral tremor and dysmetria. A new MRI in June showed three new non-enhancing supratentorial lesions. She was diagnosed with MS and at a follow-up in September the symptoms in the upper extremities had worsened. She received prednisolone treatment and was started on interferon β therapy. In November she had Lhermitte's sign and MRI showed a cervical spine lesion. Except for one occurrence of lower extremity symptoms in 2005, she has remained relapse free as of the latest neurological follow-up in March 2013.


Radiologically isolated syndrome: an uncommon finding at a university clinic in a high-prevalence region for multiple sclerosis.

Granberg T, Martola J, Aspelin P, Kristoffersen-Wiberg M, Fredrikson S - BMJ Open (2013)

Axial fluid attenuated inversion recovery images of the identified radiologically isolated syndrome patient illustrating the multiple T2 hyperintensities and the contrast-enhancing lesion in the far right image.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3822304&req=5

BMJOPEN2013003531F2: Axial fluid attenuated inversion recovery images of the identified radiologically isolated syndrome patient illustrating the multiple T2 hyperintensities and the contrast-enhancing lesion in the far right image.
Mentions: The patient with RIS was a 43-year-old woman without any neurological symptoms or any history of neurological disorders except for migraine since more than 10 years. A neurological examination did not reveal any pathological findings. She had good effect of triptanes. Owing to her long history of migraine and still frequent attacks she was referred for MRI of the brain in February 2001. The scan showed 15 supratentorial T2 lesions, of which 12 were periventricular and 2 were juxtacortical. Gadolinium-enhanced sequences showed enhancement in one of the lesions. Thus three of the four of the Barkhof criteria were fulfilled.31 Images obtained from this patient can be seen in figure 2. Owing to the MRI findings, she was referred to a neurologist in March where a second neurological examination was normal. Cerebrospinal fluid analysis revealed oligoclonal bands and an elevated IgG index. In May she returned to the neurological clinic due to a sudden onset of intermittent bilateral symptoms in arms and hands. A new neurological examination revealed bilateral tremor and dysmetria. A new MRI in June showed three new non-enhancing supratentorial lesions. She was diagnosed with MS and at a follow-up in September the symptoms in the upper extremities had worsened. She received prednisolone treatment and was started on interferon β therapy. In November she had Lhermitte's sign and MRI showed a cervical spine lesion. Except for one occurrence of lower extremity symptoms in 2005, she has remained relapse free as of the latest neurological follow-up in March 2013.

Bottom Line: The improved availability of MRI in medicine has led to an increase in incidental findings.RIS, according to present criteria, is an uncommon finding in a tertiary hospital setting in a high-prevalence region for MS where awareness and clinical suspicion of MS is common.In order to study the prognosis of RIS, multicentre studies, or case-control studies are recommended.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.

ABSTRACT

Objective: The improved availability of MRI in medicine has led to an increase in incidental findings. Unexpected brain MRI findings suggestive of multiple sclerosis (MS) without typical symptoms of MS were recently defined as radiologically isolated syndrome (RIS). The prevalence of RIS is uncertain. The aim of this study was to determine the prevalence of RIS at a university hospital in a region with a high prevalence for MS and describe the long-term prognosis of the identified patients.

Design: Retrospective cohort study conducted in 2012.

Setting: All brain MRI examinations performed at Karolinska University Hospital in Huddinge, Stockholm, Sweden during 2001 were retrospectively screened by a single rater for findings fulfilling the Okuda criteria. The sample year was chosen in order to establish the long-term prognosis of the patients identified. The examinations of interest were re-evaluated according to the Barkhof criteria by a neuroradiologist with long experience in MS.

Participants: In total 2105 individuals were included in the study. Ages ranged from 0 to 90 years with a median age of 48 years. Only one patient with RIS was identified, equivalent to a prevalence of 0.05% in the studied population, or 0.15% among patients aged 15-40 years. The patient with RIS developed symptoms consistent with MS within 3 months accompanied with radiological progression and was diagnosed with MS.

Conclusions: RIS, according to present criteria, is an uncommon finding in a tertiary hospital setting in a high-prevalence region for MS where awareness and clinical suspicion of MS is common. In order to study the prognosis of RIS, multicentre studies, or case-control studies are recommended.

No MeSH data available.


Related in: MedlinePlus