Vilaseca Andreu, Vidal-Jordana Angela, Sceppacuercia Sofia, Calderon Willem, Arrambide Georgina, Rio Jordi, Tur Carmen, Rodriguez-Acevedo Breogan, Ariño Helena, Zabalza Ana, Cobo-Calvo Alvaro, Mongay-Ochoa Neus, Carbonell-Mirabent Pere, Pappolla Agustín, Carvajal René, Castilló Joaquín, Galan Ingrid, Midaglia Luciana, Bollo Luca, Villacieros-Álvarez Javier, Auger Cristina, Sastre-Garriga Jaume, Tintoré Mar, Comabella Manuel, Rovira Àlex, Montalban Xavier
Neurology Department and Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari de Vall d'Hebron, Barcelona, Spain.
Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
Mult Scler. 2025 Jun;31(7):771-781. doi: 10.1177/13524585251332115. Epub 2025 May 30.
Radiologically isolated syndrome (RIS) represents a subclinical period of multiple sclerosis (MS).
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.
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.
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).
Our findings support the utility of the current DIS component of the 2017 McDonald MS criteria for RIS patients.
放射学孤立综合征（RIS）代表多发性硬化症（MS）的亚临床期。
我们旨在描述RIS队列中MS发生的特征并确定其危险因素，并评估各种提议的RIS定义对MS发生的预测价值。
这项队列研究纳入了所有在脑和/或脊髓磁共振成像（MRI）上至少有一个提示MS的典型炎性脱髓鞘病变的患者。MS症状的出现和新的T2病变分别为主要和次要结局。采用Cox回归确定危险因素，并评估诊断性能。
共纳入88例患者，在平均55.1个月的随访中，25.0%出现了MS症状。年龄较小以及脊髓和皮质/近皮质病变与较差的结局相关。2017年麦克唐纳空间扩散（DIS）标准和2023年勒布伦RIS定义，分别对应2005年麦克唐纳DIS标准或一个与寡克隆带中的两个、一个脊髓病变以及放射学随访期间的时间扩散相关的脑炎性脱髓鞘病变，显示出高敏感性（分别为0.82和0.94）。然而，仅考虑2023年勒布伦RIS定义的基线特征时，敏感性降低（0.79）。将2017年麦克唐纳DIS标准与基线MRI上寡克隆带阳性或对比增强病变阳性相结合，即当前的麦克唐纳MS标准，提高了特异性（分别提高到0.64和0.90）。
我们的研究结果支持2017年麦克唐纳MS标准中当前DIS成分对RIS患者的实用性。
