Rim and flame signs: Postgadolinium MRI findings specific for Non-CNS intramedullary spinal cord metastases

J. B. Rykken, F. E. Diehn, C. H. Hunt, L. J. Eckel, K. M. Schwartz, Timothy J Kaufmann, J. T. Wald, Caterina Giannini, C. P. Wood

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE: No highly specific MR imaging features distinguishing ISCMs from primary cord masses have been described. Our purpose was to retrospectively compare peripheral enhancement features on postgadolinium MR imaging of ISCMs with primary intramedullary cord masses. MATERIALS AND METHODS: A consecutive group of patients with firmly diagnosed ISCM (45 patients with 64 ISCMs) and a comparison group with consecutive pathologically proved primary intramedullary spinal cord masses (64 patients with 64 primary spinal cord masses: ependymoma, astrocytoma, hemangioblastoma, ganglioglioma, and cavernous malformation) were included. MR images were evaluated for 2 specific signs on postgadolinium images: a 'rim' sign (more intense thin rim of peripheral enhancement around an enhancing lesion) and 'flame' sign (ill-defined flame-shaped region of enhancement at the superior/inferior lesion margins). The frequency of rim and/or flame signs in ISCMs and primary cord masses was compared (x2 test). For ISCMs, the maximal dimension of the enhancing lesion was correlated with the presence of rim or flame signs (t test). RESULTS: Rim and flame signs, alone and in combination, were seen more frequently in ISCMs than in primary cord masses (P .0001 for each). Specificity and sensitivity, respectively, for diagnosing ISCMs among spinal cord masses on a per-patient basis were the following: rim sign, 97%, 47%; flame sign, 97%, 40%; at least 1 sign, 94%, 60%; and both signs concurrently, 100%, 27%. In the ISCM group, the presence of either a rim or flame sign correlated with a larger measured maximum enhancing lesion size (P .0065 and P .0012, respectively). CONCLUSIONS: The rim and flame signs are common in and specific for ISCM and are rare in primary spinal cord masses.

Original languageEnglish (US)
Pages (from-to)908-915
Number of pages8
JournalAmerican Journal of Neuroradiology
Volume34
Issue number4
DOIs
StatePublished - Apr 2013

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Spinal Cord
Neoplasm Metastasis
Ganglioglioma
Hemangioblastoma
Ependymoma
Astrocytoma
Sensitivity and Specificity

ASJC Scopus subject areas

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging

Cite this

Rim and flame signs : Postgadolinium MRI findings specific for Non-CNS intramedullary spinal cord metastases. / Rykken, J. B.; Diehn, F. E.; Hunt, C. H.; Eckel, L. J.; Schwartz, K. M.; Kaufmann, Timothy J; Wald, J. T.; Giannini, Caterina; Wood, C. P.

In: American Journal of Neuroradiology, Vol. 34, No. 4, 04.2013, p. 908-915.

Research output: Contribution to journalArticle

Rykken, J. B. ; Diehn, F. E. ; Hunt, C. H. ; Eckel, L. J. ; Schwartz, K. M. ; Kaufmann, Timothy J ; Wald, J. T. ; Giannini, Caterina ; Wood, C. P. / Rim and flame signs : Postgadolinium MRI findings specific for Non-CNS intramedullary spinal cord metastases. In: American Journal of Neuroradiology. 2013 ; Vol. 34, No. 4. pp. 908-915.
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abstract = "BACKGROUND AND PURPOSE: No highly specific MR imaging features distinguishing ISCMs from primary cord masses have been described. Our purpose was to retrospectively compare peripheral enhancement features on postgadolinium MR imaging of ISCMs with primary intramedullary cord masses. MATERIALS AND METHODS: A consecutive group of patients with firmly diagnosed ISCM (45 patients with 64 ISCMs) and a comparison group with consecutive pathologically proved primary intramedullary spinal cord masses (64 patients with 64 primary spinal cord masses: ependymoma, astrocytoma, hemangioblastoma, ganglioglioma, and cavernous malformation) were included. MR images were evaluated for 2 specific signs on postgadolinium images: a 'rim' sign (more intense thin rim of peripheral enhancement around an enhancing lesion) and 'flame' sign (ill-defined flame-shaped region of enhancement at the superior/inferior lesion margins). The frequency of rim and/or flame signs in ISCMs and primary cord masses was compared (x2 test). For ISCMs, the maximal dimension of the enhancing lesion was correlated with the presence of rim or flame signs (t test). RESULTS: Rim and flame signs, alone and in combination, were seen more frequently in ISCMs than in primary cord masses (P .0001 for each). Specificity and sensitivity, respectively, for diagnosing ISCMs among spinal cord masses on a per-patient basis were the following: rim sign, 97{\%}, 47{\%}; flame sign, 97{\%}, 40{\%}; at least 1 sign, 94{\%}, 60{\%}; and both signs concurrently, 100{\%}, 27{\%}. In the ISCM group, the presence of either a rim or flame sign correlated with a larger measured maximum enhancing lesion size (P .0065 and P .0012, respectively). CONCLUSIONS: The rim and flame signs are common in and specific for ISCM and are rare in primary spinal cord masses.",
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AU - Rykken, J. B.

AU - Diehn, F. E.

AU - Hunt, C. H.

AU - Eckel, L. J.

AU - Schwartz, K. M.

AU - Kaufmann, Timothy J

AU - Wald, J. T.

AU - Giannini, Caterina

AU - Wood, C. P.

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