Loss of the insular ribbon sign
Last revised by Magdi Mahsoub
on 15 Feb 2025
Citation, DOI, disclosures and article data
Citation:
Weerakkody Y, Mahsoub M, AL-Boany I, et al. Loss of the insular ribbon sign. Reference article, Radiopaedia.org (Accessed on 11 Mar 2025) https://radiopaedia.org/articles/17939
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rID:
17939
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Disclosures:
At the time the article was created Yuranga Weerakkody had no recorded disclosures.
View Yuranga Weerakkody's current disclosures
Last revised:
15 Feb 2025,
Magdi Mahsoub
Disclosures:
At the time the article was last revised Magdi Mahsoub had no financial relationships to ineligible companies to disclose.
View Magdi Mahsoub's current disclosures
Revisions:
17 times, by
15 contributors -
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Synonyms:
- Loss of the insular ribbon (LIR)
- LIR sign
- Loss of the insular ribbon
- Insular ribbon loss
- Insular ribbon sign
The loss of the insular ribbon sign refers to a loss of definition of the gray-white interface in the lateral margin of the insular cortex ("insular ribbon") and is considered an early (hyperacute to acute) CT sign of MCA territory infarction.
The insular cortex is more susceptible to ischemia following MCA occlusion than other portions of the MCA territory because it has the least potential for collateral supply from the anterior cerebral and posterior cerebral arteries.
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Quiz questions
References
- 1. Truwit CL, Barkovich AJ, Gean-marton A et-al. Loss of the insular ribbon: another early CT sign of acute middle cerebral artery infarction. Radiology. 1990;176 (3): 801-6. Radiology (abstract) - Pubmed citation
- 2. Nakano S, Iseda T, Kawano H et-al. Correlation of early CT signs in the deep middle cerebral artery territories with angiographically confirmed site of arterial occlusion. AJNR Am J Neuroradiol. 2001;22 (4): 654-9. AJNR Am J Neuroradiol (full text) - Pubmed citation
- 3. Sarikaya B, Provenzale J. Frequency of various brain parenchymal findings of early cerebral ischemia on unenhanced CT scans. Emerg Radiol. 2010;17 (5): 381-90. doi:10.1007/s10140-010-0870-2 - Pubmed citation
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Articles:
Cases:
- MCA territory acute infarction with hyperdense MCA sign
- Acute middle cerebral artery ischaemic stroke
- Hyperdense MCA sign
- Early left MCA infarct
- Acute MCA territory infarct
- Hyperdense MCA and loss of the insular ribbon signs
- Right insular cortex infarct
- Acute right MCA stroke
- Left MCA occlusion - thrombectomy
- Middle cerebral artery territory hyperacute infarct
- Malignant middle cerebral artery infarction
- Ischaemic stroke
- Loss of the insular ribbon sign
- Hyperacute infarction
- Acute ischaemic stroke: dense MCA sign
- Left MCA stroke - dense MCA sign
- Middle cerebral artery territory infarct
- Middle cerebral artery hyperacute infarct
- Hyperdense MCA sign
- Loss of insular ribbon sign
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