Diagnostics and management of patients with radiologically isolated syndrome

Česká verze

Authors: M. Petrášová; M. Hladíková; J. Kočica
Authors place of work: Neurologická klinika LF MU a FN Brno
Published in the journal: Cesk Slov Neurol N 2025; 88(4): 203-209
doi: https://doi.org/10.48095/cccsnn2025203

Summary

Radiologically isolated syndrome (RIS) represents one of the earliest identifiable stages of MS, characterized by the presence of asymptotic demyelinating lesions on MRI corresponding to MS. With the increasing availability of MRI, these incidental findings are being detected more frequently and their prognostic significance and therapeutic implications are becoming the subject of intensive research. In this review article, we summarize the development of RIS diagnostic criteria –⁠ from their initial formulation in 2009 to the recent 2023 revision. We focus on risk factors for conversion of RIS to clinical MS, on differential diagnosis, useful biomarkers (including the central vein sign, oligoclonal bands, kappa index, and neurofilament light chain levels) and the early interventional trials evaluating the effectiveness of disease-modifying drugs in patients with RIS –⁠ teriflunomide and dimethyl fumarate were among the first to demonstrate the ability to delay the first clinical attack. Previous studies underline the importance of accurately stratifying patients based on a combination of radiological, laboratory, and demographic data, which can help identify individuals at the highest risk of early conversion. This review aims to promote a clinical understanding of RIS and highlight its growing importance, particularly in relation to its position within the newly prepared diagnostic criteria for MS from 2024.

Keywords:

prognostic factors – Multiple sclerosis – magnetic resonance imaging – risk stratification – oligoclonal bands – radiologically isolated syndrome – neurofilament – teriflunomide – dimethyl fumarate

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