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Background: The discovery and broad application of MRI in medicine has led to an increased awareness in the number of patients with incidental white matter pathology in the CNS. Routinely encountered in clinical practice, the natural history or evolution of such individuals with respect to their risk of developing multiple sclerosis (MS) is unclear.

Objective: To investigate the natural history of patients who exhibit incidental imaging findings highly suggestive of MS pathology.

Methods: Detailed clinical and radiologic data were obtained from asymptomatic patients with MRI anomalies suggestive of MS.

Results: The cohort consisted of 41 female and 3 male subjects (median age = 38.5, range: 16.2–67.1). Clinical evaluations were performed in 44 patients at the time of initial imaging; longitudinal clinical follow-up occurred for 30 patients, and longitudinal MRI data were acquired for 41 patients. Neurologic …