Open-Ring Enhancement in Pseudotumoral Multiple Sclerosis: Important Radiological Aspect

Abstract

Introduction. Observation of open-ring enhancement in magnetic resonance imaging (MRI) is considered a specificity marker for diagnosing pseudotumoral multiple sclerosis (MS). This finding is of great value in the differential diagnosis of tumefactive lesions. Case Report. We describe a 55-year-old white woman, with previous history of ovarian cancer and recent history of fatigue and bilateral retroorbital pain. Important bilateral visual impairment evolved over one month. Physical examination detected the presence of right homonymous hemianopia. Cranial MRI showed an expanding lesion with open-ring enhancement. Given the range of diagnostic possibilities, a stereotactic biopsy was performed, and histopathological examination was consistent with an active demyelinating disease. The patient was treated with 1 g of methylprednisolone and symptoms improved following a significant reduction in the lesion. Conclusions. We highlight the MRI results suggestive of pseudotumoral MS, especially open-ring enhancement, which is an important radiologic aspect to diagnosis and can assist in avoiding unnecessary biopsies.

Brain invasion by chronic lymphocytic leukemia

“…12 In multiple sclerosis, the enhancing lesion of the open ring sign represents the area of active inflammation, while the non-enhancing area represents the inflammatory process in its most chronic phase. 13,14 In fact, myelinoclasis was confirmed pathologically in the present case. Although the cause of the myelinoclasis was unclear, the findings of occluded small arterioles by massive leukemia cell invasion to the Virchow-Robin space suggest ischemia as the cause of the myelinoclasis.…”

“…The discontinuous ring enhancement observed in the present case is similar to the open ring sign, and its specificity for demyelination is 93.8% . In multiple sclerosis, the enhancing lesion of the open ring sign represents the area of active inflammation, while the non‐enhancing area represents the inflammatory process in its most chronic phase . In fact, myelinoclasis was confirmed pathologically in the present case.…”

Vanishing Pseudotumoral White Matter Lesions Presenting as Aphasia and Altered Mental Status in a 71-Year-Old Male

“…Additionally, the diagnosis of MS could not be given at this point since no dissemination in space, time or presence of oligoclonal bands were observed [11]. In both situations, open-ring enhancement after gadolinium seems to support a demyelinating aetiology [12]. The characteristics that were considered in differentiating between these two entities are summarized in Table 1.…”

Supratentorial Extraventricular Anaplastic Ependymoma Presented With Headache in Pregnancy: Case Report and Review of the Literature

“…2016;7(7):274-281 topathological differential diagnosis from glioblastoma multiforme, primitive neuroectodermal tumors, ganglioglioma, and oligodendroglioma [3,20]. Furthermore, in the first detection of the case, it was thought that its superficial, purely cystic appearance and minimal peritumoral edema might belong to tumefactive multiple sclerosis [34]. We waited to see whether the patient would respond to the methasone.…”