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NEUROLOGY 2008;71:e73
© 2008 American Academy of Neurology
Resident and Fellow Section

Teaching NeuroImage: Open-ring imaging sign in a case of tumefactive cerebral demyelination

P. D. Smith, FRACS, PhD, M. J. Cook, FRACP, MD, N. M. Trost, MB BS, FRANZCR and M. A. Murphy, FRACS, MD

From the Centre for Clinical Neurosciences and Neurological Research (P.D.S., M.J.C., N.M.T., M.A.M.) and Department of Radiology (N.M.T.), St. Vincent’s Hospital, Melbourne, Australia.

Address correspondence and reprint requests to Dr. Paul D. Smith, St. Vincent’s Hospital, 5th Floor Daly Wing, Melbourne, VIC Australia 3065 paul{at}neurology.net.au

A 70-year-old woman presented with confusion and hemianopia. A ring-enhancing lesion revealed on MRI (figure), thought to be suggestive of lymphoma or high-grade glioma, demonstrated demyelination on biopsy. Two further biopsies due to suspicion of malignancy both confirmed demyelination. Retrospectively, the enhancement pattern on the original MRI demonstrated an "open ring" previously described in large, demyelinating lesions and of assistance in distinguishing them from tumor.1,2 Typically the ring is crescentic, involving white matter, and its open section verges on the gray matter of the cortex or basal ganglia.1,2 The sign is highly specific for demyelination.2


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  		Figure The abnormality within the right parieto-occipital lobe involving the corpus callosum with an open ring of enhancement abutting the gray matter (arrow)

(A, D) Noncontrast T1 images. (B, E) Contrast-enhanced T1 images. (C, F) FLAIR images demonstrating extensive splenium involvement.

 

Disclosure: The authors report no disclosures.


   REFERENCES
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 REFERENCES
 

  1. Masdeu JC, Moreira J, Trasi S, Visintainer P, Cavaliere R, Grundman M. The open ring: a new imaging sign in demyelinating disease. J Neuroimaging 1996;6:104–107.[Medline]
  2. Masdeu JC, Quinto C, Olivera C, Tenner M, Leslie D, Visintainer P. Open-ring imaging sign: highly specific for atypical brain demyelination. Neurology 2000;54:1427–1433.[Abstract/Free Full Text]




This Article
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