Radiologically Isolated Syndrome: from incidental findings to preclinical Multiple Sclerosis

Radiologically Isolated Syndrome (RIS) is becoming increasingly relevant as Multiple Sclerosis (MS) diagnosis moves from a purely clinical model toward a more biologically informed framework.

In this keynote, Cecilia Rajda explores how the 2024 diagnostic criteria are reshaping the definition of RIS, which patients may now fulfil criteria for MS, and what this means for diagnostic work-up, follow-up, treatment decisions and communication with patients.

Key Insights from the Lecture:

• Multiple Sclerosis may begin biologically before the first clinical symptoms appear.
• RIS describes patients with incidental imaging findings suggestive of demyelinating disease but without typical clinical manifestations of MS.
• The 2024 diagnostic framework narrows the definition of RIS because some patients previously classified as RIS may now fulfil diagnostic criteria for MS.Dissemination in space requires involvement of at least two typical central nervous system topographies.
• The five topographies discussed are periventricular, cortical or juxtacortical, infratentorial, spinal cord and optic nerve involvement.
• In patients with dissemination in space, additional features such as positive cerebrospinal fluid findings, dissemination in time or six Select-6 central vein signs may support a diagnosis of MS.
• The session highlights the importance of excluding alternative diagnoses before classifying incidental MRI findings as MS-related.
• Clinical history, neurological examination, imaging, laboratory testing and differential diagnosis remain essential parts of the assessment.
• The updated framework introduces concepts such as preclinical MS, incidental MS and radiologically isolated MS.
• Not every patient with an RIS-type presentation will necessarily want treatment, even when diagnostic criteria for MS are fulfilled.
• Access to treatment may also depend on national healthcare policies and reimbursement criteria.Important unanswered questions remain around how extensively patients with RIS should be investigated, the risk of overdiagnosis, and when treatment should be initiated.

“Detecting progression in Multiple Sclerosis: practical approaches and emerging tools”.

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About the speaker:

Cecilia Rajda

Cecilia Rajda works as an associate professor at the Department of Neurology, University of Szeged. She has a special interest in neuroimmunology, serves as a vice-president in the Hungarian Neuroimmunology Society and is responsible for the Multiple Sclerosis Platform. She was an invited speaker at the European Academy of Neurology and European Congress on Treatment and Research in Multiple Sclerosis.

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