TY - JOUR
T1 - The open ring
T2 - A new imaging sign in demyelinating disease
AU - Masdeu, Joseph C.
AU - Moreira, Joseph
AU - Trasi, Sunil
AU - Visintainer, Paul
AU - Cavaliere, Rossella
AU - Grundman, Michael
N1 - Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 1996
Y1 - 1996
N2 - Because demyelinating disease of the brain occasionally presents with large ring-enhancing lesions on computed tomography (CT) scans and magnetic resonance images (MRIs), the authors sought to determine whether the ring pattern differed from that found in other common brain lesions with ring enhancement. Published MRI and CT scans of patients with adrenoleukodystrophy (23), and multiple sclerosis or similar demyelinating disorders (21), as well as a variety of tumors (44) and infections (44) matched to the demyelinating lesions by year of publication, in which ring enhancement was evident, were photographed. Photographs without diagnostic identification were presented randomly to two independent observers. The observers rated the contrast enhancement pattern as (1) open ring, with enhancement in the border of the lesion abutting the white matter; (2) closed ring; or (3) uncertain. For all diagnostically certain cases (n = 112), interrater agreement was excellent (κ = 0.75). As an average of the two reviewers, scans for 11 of 132 cases were read as uncertain; 89% of adrenoleukodystrophy cases, 41% of the multiple sclerosis cases, 3% of tumors, and 9% of infections were classified as having the open-ring pattern. Overall, 66% of demyelinating lesions had an open-ring pattern compared with 7% of the nondemyelinating lesions (χ2 = 41.2, p < 0.0001). An open-ring pattern of enhancement is more likely to be associated with de myelinating lesions than with nondemyelinating lesions.
AB - Because demyelinating disease of the brain occasionally presents with large ring-enhancing lesions on computed tomography (CT) scans and magnetic resonance images (MRIs), the authors sought to determine whether the ring pattern differed from that found in other common brain lesions with ring enhancement. Published MRI and CT scans of patients with adrenoleukodystrophy (23), and multiple sclerosis or similar demyelinating disorders (21), as well as a variety of tumors (44) and infections (44) matched to the demyelinating lesions by year of publication, in which ring enhancement was evident, were photographed. Photographs without diagnostic identification were presented randomly to two independent observers. The observers rated the contrast enhancement pattern as (1) open ring, with enhancement in the border of the lesion abutting the white matter; (2) closed ring; or (3) uncertain. For all diagnostically certain cases (n = 112), interrater agreement was excellent (κ = 0.75). As an average of the two reviewers, scans for 11 of 132 cases were read as uncertain; 89% of adrenoleukodystrophy cases, 41% of the multiple sclerosis cases, 3% of tumors, and 9% of infections were classified as having the open-ring pattern. Overall, 66% of demyelinating lesions had an open-ring pattern compared with 7% of the nondemyelinating lesions (χ2 = 41.2, p < 0.0001). An open-ring pattern of enhancement is more likely to be associated with de myelinating lesions than with nondemyelinating lesions.
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U2 - 10.1111/jon199662104
DO - 10.1111/jon199662104
M3 - Article
C2 - 8634482
AN - SCOPUS:0029967545
SN - 1051-2284
VL - 6
SP - 104
EP - 107
JO - Journal of Neuroimaging
JF - Journal of Neuroimaging
IS - 2
ER -