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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 …