Open ring sign
Citation, DOI, disclosures and article data
At the time the article was created Frank Gaillard had no recorded disclosures.
View Frank Gaillard's current disclosuresAt the time the article was last revised Frank Gaillard had the following disclosures:
- Biogen Australia Pty Ltd, Investigator-Initiated Research Grant for CAD software in multiple sclerosis: finished Oct 2021 (past)
These were assessed during peer review and were determined to not be relevant to the changes that were made.
View Frank Gaillard's current disclosures- Incomplete ring enhancement sign
- Open ring enhancement
The open ring sign is a relatively specific sign for demyelination, most commonly multiple sclerosis (MS), and is helpful in distinguishing between the causes of ring-enhancing lesions.
Radiographic features
The enhancing component is thought to represent advancing front of demyelination and thus favors the white matter side of the lesion. The open part of the ring will therefore usually point towards the grey matter 3.
Treatment and prognosis
Often patients with such lesions undergo biopsy, where the histology can be difficult to interpret. Abundant bizarre astrocytes with frequent mitoses can suggest the diagnosis of glioblastoma. Toxoplasmosis may also be suggested by the presence of giant cells (Creutzfeldt cells).
As such, careful assessment of imaging is essential to avoid unnecessary and misleading intervention.
Quiz questions
References
- 1. Masdeu JC, Quinto C, Olivera C et-al. Open-ring imaging sign: highly specific for atypical brain demyelination. Neurology. 2000;54 (7): 1427-33. Neurology (full text) - Pubmed citation
- 2. Siddiqui A, Sahni A, Khadilkar S. The open-ring sign. Neurol India. 2005;53 (2): 253-4. Neurol India (link) - Pubmed citation
- 3. Given CA, Stevens BS, Lee C. The MRI appearance of tumefactive demyelinating lesions. AJR Am J Roentgenol. 2004;182 (1): 195-9. AJR Am J Roentgenol (full text) - Pubmed citation
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