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Updated: Apr 29, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Open-ring enhancement in pseudotumoral multiple sclerosis: important radiological aspect
Frederico Carvalho de Medeiros1, Lucas Alverne Freitas de Albuquerque2, Jose Eymard Homem Pittella3
1Department of Neurology, Santa Casa de Belo Horizonte, MG, Brazil.
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.
Insights
Open-ring enhancement on magnetic resonance imaging (MRI) is a key indicator for diagnosing pseudotumoral multiple sclerosis (MS). This specific MRI finding aids in differentiating tumefactive lesions, potentially avoiding invasive biopsies.
Area of Science:
- Neurology
- Radiology
- Pathology
Background:
- Open-ring enhancement on MRI is a specificity marker for diagnosing pseudotumoral multiple sclerosis (MS).
- This finding is crucial for the differential diagnosis of tumefactive lesions.
Purpose of the Study:
- To highlight the significance of MRI findings, particularly open-ring enhancement, in diagnosing pseudotumoral MS.
- To emphasize the role of this radiologic aspect in differential diagnosis and potentially avoiding unnecessary biopsies.
Main Methods:
- Case report of a 55-year-old woman presenting with fatigue, retroorbital pain, and visual impairment.
- Cranial MRI revealed an expanding lesion with open-ring enhancement.
- Stereotactic biopsy confirmed active demyelinating disease.
Main Results:
- The patient exhibited right homonymous hemianopia and an MRI lesion with open-ring enhancement.
- Histopathological examination confirmed active demyelinating disease consistent with MS.
- Treatment with methylprednisolone led to symptom improvement and lesion reduction.
Conclusions:
- Open-ring enhancement on MRI is a strong indicator for pseudotumoral MS.
- This radiologic sign is valuable in differentiating tumefactive lesions.
- Recognizing this MRI pattern can help avoid unnecessary invasive procedures like biopsies.
