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Open-ring imaging sign: highly specific for atypical brain demyelination.
J C Masdeu1, C Quinto, C Olivera
1Departments of Neurology, New York Medical College (St. Vincent's Hospital and Westchester Medical Center), Valhalla, NY , USA. masdeu@nymc.edu
Neurology
|April 6, 2000
Summary
The new open-ring sign on neuroimaging can help distinguish demyelinating brain lesions from tumors and infections. This imaging finding shows high specificity for demyelination, aiding in differential diagnosis.
Area of Science:
- Neuroimaging
- Radiology
- Neuropathology
Background:
- Brain demyelination can manifest as ring-enhancing lesions on CT and MRI.
- These lesions often mimic neoplasms or infections, complicating diagnosis.
Purpose of the Study:
- To evaluate the diagnostic specificity of a novel neuroimaging sign: the open-ring or crescent-shaped contrast enhancement.
- This sign is circumscribed to the white matter and assessed for its ability to differentiate demyelination.
Main Methods:
- A systematic literature search identified 32 pathology-proven demyelinating cases with ring enhancement.
- Control cases of pathology-proven neoplasms and infections were matched for publication year, patient age, and gender.
- Two neuroradiologists independently reviewed all images twice, with a one-year interval.
Main Results:
- The open-ring sign demonstrated good interrater reliability (kappa = 0.64-0.66) and high test-retest reliability (kappa = 0.74-0.75).
- Specificity for identifying demyelinating lesions was 93.8% for the first reader and 84.4% for the second.
- Likelihood ratios indicated demyelination was 5.2 times more likely than neoplasm and 17.2 times more likely than infection in the presence of the sign, though common conditions still account for many open-ring enhancements.
Conclusions:
- The open-ring sign is a valuable indicator in large, contrast-enhancing demyelinating lesions.
- This neuroimaging finding aids in differentiating demyelinating diseases from neoplasms and infections.