Open-ring imaging sign

Masdeu, Joseph C.; Quinto, Christine; Olivera, Caridad Villar; Tenner, Michael; Leslie, Denise; Visintainer, Paul

doi:10.1212/wnl.54.7.1427

Cited by 185 publications

(113 citation statements)

References 22 publications

Supporting

Mentioning

104

Contrasting

Unclassified

Order By: Relevance

“…In most cases, CT imaging shows low or modest densities, while MRI shows abnormal long T1 and T2 signals. In the literature, the majority of demyelinating pseudotumor cases presented with non-closed ring enhancements (also called crescent sign) on CT and (or) MRI scans (11,12). However, intracranial tumors often lack this signal (13,18).…”

Section: █ Discussionmentioning

confidence: 99%

Intracranial demyelinating pseudotumor: a case report and review of the literature

Ning

Zhao²,

Wang³

et al. 2014

Turkish Neurosurgery

View full text Add to dashboard Cite

ABSTRACTpseudotumor in the clinic is relative low, delayed diagnosis or misdiagnosis may cause delays in treatment of these patients and subsequently may lead to physical and mental damage (14). The differential diagnosis of demyelinating pseudotumor and brain tumors, especially of low-grade astrocytomas, should arouse more attention to exclude the possibility of a demyelinating process. Despite this, only few reported cases of intracranial demyelinating pseudotumor are known in the literature. In this case report, we present the diagnosis and treatment of a demyelinating pseudotumor patient who was misdiagnosed with astrocytoma. █ CASE REPORTA female 40-year-old patient was hospitalized due to a progressive disability of the left limb that severely increased over one week. The patient did not have a recent history █ INTRODUCTION D emyelinating pseudotumor of the brain, also called tumor-like demyelinating lesions (TDLs) or inflammatory demyelinating pseudotumor (IDP), is a rare inflammatory demyelinating disease of the central nervous system (CNS) (3,4,7,8). The exact etiology of demyelinating pseudotumor is unclear, however it may associate with multiple sclerosis (MS) (5). Based on the clinical presentation and computed tomography (CT) and magnetic resonance imaging (MRI) findings, it is difficult to distinguish between brain tumors, abscesses and demyelinating pseudotumors (13). Unlike brain tumors, demyelinating pseudotumors respond well to steroid hormones (6). Therefore, a reliable distinction between brain tumors and intracranial demyelinating pseudotumors is important for a targeted therapy. Although the incidence of demyelinating Demyelinating pseudotumor is a rare inflammatory demyelinating disease of the central nervous system (CNS) that has a similar clinical presentation and computed tomography (CT) and magnetic resonance imaging (MRI) imaging findings as brain tumors or abscesses. Unlike brain tumors, demyelinating pseudotumors respond well to steroid hormones. There are only a few reported cases of intracranial demyelinating pseudotumors in the literature. In this case report, we present the diagnosis and treatment of demyelinating pseudotumor in a patient whose condition was initially misdiagnosed as an astrocytoma. Based on the literature and our case, we formulated an outline for the differential diagnosis of demyelinating pseudotumor and astrocytoma. A timely and correct diagnosis of demyelinating pseudotumor would avoid blind surgery, radiotherapy and chemotherapy, which are used to treat brain tumors.

show abstract

Section: █ Discussionmentioning

confidence: 99%

Intracranial demyelinating pseudotumor: a case report and review of the literature

Ning

Zhao²,

Wang³

et al. 2014

Turkish Neurosurgery

View full text Add to dashboard Cite

show abstract

“…1 A TDL misdiagnosed as a neoplasm could lead to unnecessary surgical intervention or even radiation therapy, which could exacerbate demyelinating diseases. 2 Certain conventional MR imaging features, including a relative lack of mass effect, less substantial perifocal edema, and an open ring of enhancement, 1,3,4 which were previously thought to be characteristics of TDLs, were considered to be nonspecific in a more recent study reviewing the conventional MR imaging findings of 168 patients with biopsy-confirmed TDLs. 5 TDLs can also be confused with high-grade gliomas on histopathologic evaluation because of the presence of hypercellularity and atypical reactive astrocytes with mitotic figures.…”

mentioning

confidence: 99%

Differentiation of Tumefactive Demyelinating Lesions from High-Grade Gliomas with the Use of Diffusion Tensor Imaging

Toh

Wei

et al. 2011

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

show abstract

“…Note the ring-enhancing lesion appearing at baseline that has corresponding T1 hypointensity (solid arrow). The ring enhancement has an incomplete or open ring that is typical of MS. 10 The T1 hypointensity resolves 2 months later. A second T1 hypointensity develops over 2 months (broken arrow).…”

Section: Fig 2 Evolution Of T1 Hypointensities ("Black Holes")mentioning

confidence: 98%

“…2). 10 A complete ring may also be seen, particularly when the lesions are confined to the white matter (FIG. 3).…”

Section: Lesion Evolutionmentioning

confidence: 99%

Imaging of multiple sclerosis: Role in neurotherapeutics

Bakshi¹,

Minagar²,

Jaisani³

et al. 2005

Neurotherapeutics

View full text Add to dashboard Cite

Summary:Magnetic resonance imaging (MRI) plays an everexpanding role in the evaluation of multiple sclerosis (MS). This includes its sensitivity for the diagnosis of the disease and its role in identifying patients at high risk for conversion to MS after a first presentation with selected clinically isolated syndromes. In addition, MRI is a key tool in providing primary therapeutic outcome measures for phase I/II trials and secondary outcome measures in phase III trials. The utility of MRI stems from its sensitivity to longitudinal changes including those in overt lesions and, with advanced MRI techniques, in areas affected by diffuse occult disease (the so-called normalappearing brain tissue). However, all current MRI methodology suffers from limited specificity for the underlying histopathology. Conventional MRI techniques, including lesion detection and measurement of atrophy from T1-or T2-weighted images, have been the mainstay for monitoring disease activity in clinical trials, in which the use of gadolinium with T1-weighted images adds additional sensitivity and specificity for areas of acute inflammation. Advanced imaging methods including magnetization transfer, fluid attenuated inversion recovery, diffusion, magnetic resonance spectroscopy, functional MRI, and nuclear imaging techniques have added to our understanding of the pathogenesis of MS and may provide methods to monitor therapies more sensitively in the future. However, these advanced methods are limited by their cost, availability, complexity, and lack of validation. In this article, we review the role of conventional and advanced imaging techniques with an emphasis on neurotherapeutics.

show abstract

Open-ring imaging sign

Abstract: The open-ring sign is often present in large, contrast-enhancing demyelinating lesions and helps to differentiate them from neoplasms and infections.

Cited by 185 publications

References 22 publications

Intracranial demyelinating pseudotumor: a case report and review of the literature

Intracranial demyelinating pseudotumor: a case report and review of the literature

Differentiation of Tumefactive Demyelinating Lesions from High-Grade Gliomas with the Use of Diffusion Tensor Imaging

Imaging of multiple sclerosis: Role in neurotherapeutics

Contact Info

Product

Resources

About