Demyelination - incomplete ring enhancement

Case contributed by A.Prof Frank Gaillard

Presentation

Young woman with focal neurology.

Patient Data

Age: Young adult
Gender: Female

This contrast-enhanced T1-weighted MR image demonstrates the incomplete ring enhancement sign, which can be seen in demyelinating processes such as multiple sclerosis or ADEM

Case Discussion

When demyelinating lesions are present within the hemispheric white matter, they are typically ovoid with the long axis aligned with medullary veins (ie perpendicular to the lateral ventricles). 

Enhancement is highly variable, from none to ring to solid. Enhancement implies active demyelination. Diffusion restriction is also variable, with high, intermediate and low apparent diffusion coefficients often present in the same study. Lesions may show central T1 hypointensity, which may reflect oedema, necrosis or gliosis, depending on lesion age. 

Concentric rings may be present, often best seen on T2W images.

Case courtesy of Dr Laughlin Dawes

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Case information

rID: 10346
Case created: 8th Aug 2010
Last edited: 20th Nov 2015
Tag: ms
Inclusion in quiz mode: Included

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