Incidence of Radiologically Isolated Syndrome: A Population-Based Study

Abstract

Background and purpose: Incidental MR imaging findings resembling MS in asymptomatic individuals, fulfilling the Okuda criteria, are termed "radiologically isolated syndrome." Those with radiologically isolated syndrome are at high risk of their condition converting to MS. The epidemiology of radiologically isolated syndrome remains largely unknown, and there are no population-based studies, to our knowledge. Our aim was to study the population-based incidence of radiologically isolated syndrome in a high-incidence region for MS and to evaluate the effect on radiologically isolated syndrome incidence when revising the original radiologically isolated syndrome criteria by using the latest radiologic classification for dissemination in space.

Materials and methods: All 2272 brain MR imaging scans in 1907 persons obtained during 2013 in the Swedish county of Västmanland, with a population of 259,000 inhabitants, were blindly evaluated by a senior radiologist and a senior neuroradiologist. The Okuda criteria for radiologically isolated syndrome were applied by using both the Barkhof and Swanton classifications for dissemination in space. Assessments of clinical data were performed by a radiology resident and a senior neurologist.

Results: The cumulative incidence of radiologically isolated syndrome was 2 patients (0.1%), equaling an incidence rate of 0.8 cases per 100,000 person-years, in a region with an incidence rate of MS of 10.2 cases per 100,000 person-years. There was no difference in the radiologically isolated syndrome incidence rate when applying a modified version of the Okuda criteria by using the newer Swanton classification for dissemination in space.

Conclusions: Radiologically isolated syndrome is uncommon in a high-incidence region for MS. Adapting the Okuda criteria to use the dissemination in space-Swanton classification may be feasible. Future studies on radiologically isolated syndrome may benefit from a collaborative approach to ensure adequate numbers of participants.

Fig 1.

Flow chart of the screening process for identifying patients with RIS.

Fig 2.

Demographics and distribution of the study population. The ages in the cohort ranged between 0 and 91 years, and the mean age was 47 years (the first and third quartiles were 30 and 66 years, respectively).

Fig 3.

Brain MR imaging WM anomalies in 61-year-old (A1–A3: T2WI) and 66-year-old (B1–B3: FLAIR) women with RIS. Open arrows show periventricular lesions, and closed arrows show juxtacortical lesions, which, together with >9 lesions, made both patients fulfill the DIS-Barkhof and DIS-Swanton criteria. Columns 1 and 2 are axial sections; column 3 shows coronal sections.