Barboza Andres G, Carnero Contentti Edgar, Curbelo Maria Celeste, Halfon Mario Javier, Rojas Juan Ignacio, Silva Berenice A, Sinay Vladimiro, Tizio Santiago, Ysrraelit Maria Celica, Alonso Ricardo
Servicio de Neurologia, Hospital Central de Mendoza, España 120, 5500, Mendoza, Argentina.
Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina.
Neurol Sci. 2021 Apr;42(4):1335-1344. doi: 10.1007/s10072-021-05069-6. Epub 2021 Jan 25.
Technological advances and greater availability of magnetic resonance imaging have prompted an increment on incidental and unexpected findings within the central nervous system. The concept of radiologically isolated syndrome characterizes a group of subjects with images suggestive of demyelinating disease in the absence of a clinical episode compatible with multiple sclerosis. Since the description of this entity, many questions have arisen; some have received responses but others remain unanswered. A panel of experts met with the objective of performing a critical review of the currently available evidence. Definition, prevalence, biological bases, published evidence, and implications on patient management were reviewed. Thirty to 50% of subjects with radiologically isolated syndrome will progress to multiple sclerosis in 5 years. Male sex, age < 37 years old, and spinal lesions increase the risk. These subjects should be evaluated by a multiple sclerosis specialist, carefully excluding alternative diagnosis. An initial evaluation should include a brain and complete spine magnetic resonance, visual evoked potentials, and identification of oligoclonal bands in cerebrospinal fluid. Disease-modifying therapies could be considered when oligoclonal bands or radiological progression is present.
At present time, radiologically isolated syndrome cannot be considered a part of the multiple sclerosis spectrum. However, a proportion of patients may evolve to multiple sclerosis, meaning it represents much more than just a radiological finding.
技术进步以及磁共振成像的更广泛应用促使中枢神经系统内偶然和意外发现有所增加。放射学孤立综合征的概念描述了一组在没有与多发性硬化症相符的临床发作情况下，影像学表现提示脱髓鞘疾病的患者。自该实体被描述以来，出现了许多问题；一些已得到解答，但其他问题仍未解决。一组专家会面的目的是对当前可用证据进行批判性审查。对定义、患病率、生物学基础、已发表证据以及对患者管理的影响进行了审查。30%至50%的放射学孤立综合征患者将在5年内进展为多发性硬化症。男性、年龄<37岁以及脊髓病变会增加风险。这些患者应由多发性硬化症专科医生进行评估，仔细排除其他诊断。初始评估应包括脑部和全脊柱磁共振成像、视觉诱发电位以及脑脊液中寡克隆带的鉴定。当存在寡克隆带或影像学进展时，可考虑使用疾病修正疗法。
目前，放射学孤立综合征不能被视为多发性硬化症谱系的一部分。然而，一部分患者可能会发展为多发性硬化症，这意味着它不仅仅是一种影像学发现。
