Glioblastoma multiforme presenting with an open ring pattern of enhancement on MR imaging.

Autor:	Kinon MD; Department of Neurological Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, New York, USA., Scoco A; Department of Neurological Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, New York, USA., Farinhas JM; Department of Neurological Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, New York, USA., Kobets A; Department of Neurological Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, New York, USA., Weidenheim KM; Department of Neurological Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, New York, USA., Yassari R; Department of Neurological Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, New York, USA., Lasala PA; Department of Neurological Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, New York, USA., Graber J; Department of Neurological Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, New York, USA.
Jazyk:	angličtina
Zdroj:	Surgical neurology international [Surg Neurol Int] 2017 Jun 13; Vol. 8, pp. 106. Date of Electronic Publication: 2017 Jun 13 (Print Publication: 2017).
DOI:	10.4103/sni.sni_35_17
Abstrakt:	Background: Intracerebral ring enhancing lesions can be the presentation of a variety of pathologies, including neoplasia, inflammation, and autoimmune demyelination. Use of a precise diagnostic algorithm is imperative in correctly treating these lesions and minimizing potential adverse treatment effects. Case Description: A 55-year-old patient presented to the hospital with complaints of a post-concussive syndrome and a non-focal neurologic exam. Imaging revealed a lesion with an open ring enhancement pattern, minimal surrounding vasogenic edema, and minimal mass effect. Given the minimal mass effect, small size of the lesion, and nonfocal neurological exam, we elected to pursue a comprehensive noninvasive neurologic workup because our differential ranged from inflammatory/infectious to neoplasm. Over the next 8 weeks, the patient's condition worsened, and repeat imaging showed marked enlargement of the lesion with a now closed ring pattern of enhancement with satellite lesions and a magnetic resonance (MR) spectroscopy and perfusion signature suggestive of neoplasm. The patient was taken to surgery for biopsy and debulking of the lesion. Surgical neuropathology examination revealed glioblastoma multiforme. Conclusion: The unique open ring enhancement pattern of this lesion on initial imaging is highly specific for a demyelinating process, however, high-grade glial neoplasms can also present with complex and irregular ring enhancement including an open ring sign. Therefore, other imaging modalities should be used, and close follow-up is warranted when the open ring sign is encountered. Competing Interests: There are no conflicts of interest.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu