TY - JOUR
T1 - Open-ring imaging sign
T2 - Highly specific for atypical brain demyelination
AU - Masdeu, Joseph C.
AU - Quinto, C.
AU - Olivera, C.
AU - Tenner, M.
AU - Leslie, D.
AU - Visintainer, P.
PY - 2000/4/11
Y1 - 2000/4/11
N2 - Objective: To test the specificity for demyelination of a new neuroimaging sign: contrast enhancement shaped as an open ring or a crescent circumscribed to the white matter. Background: Brain demyelination can cause ring enhancement mimicking neoplasm or infection on CT or MRI. Methods: A MEDLINE search of pathology-proved demyelination yielded 32 illustrated cases of ring-enhancing lesions published between 1981 and 1995. Controls consisted of the same number of published images of neoplasms and infections, pathology proved, and matched by year of publication, and age and gender of the patient. Two neuroradiologists read the images twice independently 1 year apart. Results: Interrater agreement was good (κ = 0.64 and 0.66 for either reading). Test-retest reliability was high (κ = 0.75 and 0.74 for either rater). The open-ring sign clearly distinguished demyelinating lesions from neoplasms and infections. For demyelination versus neoplasm or infection, the specificity of the reading by the first neuroradiologist was 93.8 (95% CI, 86 to 98), and that of the second was 84.4 (95% CI, 74 to 92). The likelihood ratio of demyelination versus neoplasm averaged 5.2, and versus infection, 17.2. That is, if the lesions had the same incidence in the population, in the presence of an open-ring sign demyelination would be five times more likely than neoplasm and 17 times more likely than infection. However, given the much higher incidence of neoplasms and infections, these lesions are still frequently responsible for open-ring enhancement. Conclusions: The open-ring sign is often present in large, contrast-enhancing demyelinating lesions and helps to differentiate them from neoplasms and infections.
AB - Objective: To test the specificity for demyelination of a new neuroimaging sign: contrast enhancement shaped as an open ring or a crescent circumscribed to the white matter. Background: Brain demyelination can cause ring enhancement mimicking neoplasm or infection on CT or MRI. Methods: A MEDLINE search of pathology-proved demyelination yielded 32 illustrated cases of ring-enhancing lesions published between 1981 and 1995. Controls consisted of the same number of published images of neoplasms and infections, pathology proved, and matched by year of publication, and age and gender of the patient. Two neuroradiologists read the images twice independently 1 year apart. Results: Interrater agreement was good (κ = 0.64 and 0.66 for either reading). Test-retest reliability was high (κ = 0.75 and 0.74 for either rater). The open-ring sign clearly distinguished demyelinating lesions from neoplasms and infections. For demyelination versus neoplasm or infection, the specificity of the reading by the first neuroradiologist was 93.8 (95% CI, 86 to 98), and that of the second was 84.4 (95% CI, 74 to 92). The likelihood ratio of demyelination versus neoplasm averaged 5.2, and versus infection, 17.2. That is, if the lesions had the same incidence in the population, in the presence of an open-ring sign demyelination would be five times more likely than neoplasm and 17 times more likely than infection. However, given the much higher incidence of neoplasms and infections, these lesions are still frequently responsible for open-ring enhancement. Conclusions: The open-ring sign is often present in large, contrast-enhancing demyelinating lesions and helps to differentiate them from neoplasms and infections.
KW - Brain CT
KW - Brain infection
KW - Brain MR
KW - Brain neoplasms
KW - Brain white matter
KW - Cerebral sclerosis, diffuse
KW - Contrast enhancement
KW - CT
KW - MS
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U2 - 10.1212/WNL.54.7.1427
DO - 10.1212/WNL.54.7.1427
M3 - Article
C2 - 10751251
AN - SCOPUS:0034636204
SN - 0028-3878
VL - 54
SP - 1427
EP - 1433
JO - Neurology
JF - Neurology
IS - 7
ER -