title: A prospective study of patients with brain MRI showing incidental t2 hyperintensities addressed as multiple sclerosis: a lot of work to do before treating.
abstract: BACKGROUND
  With the development of magnetic resonance imaging (MRI) and publications about radiologically isolated syndrome (RIS), a lot of patients are referred to multiple sclerosis (MS) tertiary centers to confirm diagnosis of RIS or MS when brain T2 abnormalities are identified, whatever their characteristics. We evaluate prospectively the occurrence of RIS or MS and sensitivity, specificity and predictive value of McDonald criteria in diagnosis for patients presenting with incidental brain MRI T2 lesions.
  
  
  METHODS
  The authors ran standardized procedures on 220 consecutive patients addressed by general practitioners or neurologists to confirm RIS or MS diagnosis on brain MRI and give a therapeutic advice. All patients underwent neurological tests, extensive blood screening, cerebrospinal fluid (CSF) examination, visual evoked potential (VEP) and follow-up MRI after 3, 6, 12 and 24 months to consider dissemination in time and space.
  
  
  RESULTS
  Patient characteristics were: 165 women and 55 men, mean age: 42.7 years old (23-59). The major symptom motivating MRI was headaches (39%), sensitive atypical manifestations or pain (12%), mood disorders (10%), transient visual symptoms (9%), fatigue (8%), hormonal screening (6%), vertigo (6%), cranial trauma (5%), and dummy run for clinical study (5%). After a structured analysis of T2 lesions, the suspected diagnosis was: inflammatory disease 45%, vascular 33%, non-pathological 19%, genetic 2%, and metabolic 1%. Extensive screening confirmed the proposed diagnosis in 97% of cases. Among all the 220 proposed RIS patients, only 35.4% fulfilled the 2010 McDonald criteria, and 8% can be categorized as RIS. Dissemination in time criteria was present for 82.7% of MS patients and 36% of RIS patients but none of the vascular or non-pathological T2 abnormalities.
  
  
  CONCLUSIONS
  Even if RIS was initially suspected on MRI, only a third of the patients had an inflammatory disease. Most of the patients had either non-specific T2 lesions or a non-inflammatory disease. Others were initially well categorized but had experienced clinical symptoms that could possibly be considered as a first clinical event. Overdiagnosis of MS can lead to propose an inappropriate disease-modifying therapy.
authors.affiliation: Service de Neurologie, Hôpital Pasteur, 30 voie romaine, 06002 Nice, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Lebrun
authors.affiliation: Hôpital Pasteur, 30 voie romaine, Nice, France.
authors.forename: Mikael
authors.initials: M
authors.lastname: Cohen
authors.affiliation: Hôpital Pasteur, 30 voie romaine, Nice, France.
authors.forename: Annabelle
authors.initials: A
authors.lastname: Chaussenot
authors.affiliation: Hôpital Pasteur, 30 voie romaine, Nice, France.
authors.forename: Lydiane
authors.initials: L
authors.lastname: Mondot
authors.affiliation: Hôpital Pasteur, 30 voie romaine, Nice, France.
authors.forename: Stephane
authors.initials: S
authors.lastname: Chanalet
keywords: Brain MRI; Clinically isolated syndrome; Incidentaloma; Multiple sclerosis; Neurology; Radiologically isolated syndrome T2 hypersignals