case_images: PMC10864136_01
case_images: Initial MRI revealed an intra-axial T1 low-intensity (A) and T2 high-intensity (B) lesion with no enhancing lesion (C) at the upper pons. Diffusion-weighted imaging (D), magnetic resonance spectroscopy (E), and 11C-methionine positron emission tomography (F) findings showed a suspicion of glioma.
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case_images: F1
case_images: It revealed a 12x9x10-mm well-defined, lobulated, contoured, T1 low-intensity and T2 high-intensity intra-axial lesion with equivocal gadolinium enhancement, diffusion restriction, mild choline (Cho) elevation (Cho/creatine [Cr] ratio of 1.68) with N-acetylasparate (NAA) suppression (Cho/NAA ratio of 0.82), and 11C-methionine positron emission tomography (PET) uptake at the pons, suggesting a tumorous lesion or toxic/metabolic lesion (Fig. 1).
case_images: Repeated neuroimaging study 1.5 months after the initial examination revealed no definite change in the T2 high-intensity lesion (A), neither an elevated choline peak nor a suppressed N-acetylaspartate peak on magnetic resonance spectroscopy (B), no hyperperfusion on perfusion MRI (C), and no hyper uptake on 18fluorodeoxyglucose positron emission tomography compared with normal brain parenchyma (D).
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case_images: PMC10864136_01_btrt-12-58-g002.jpg
case_images: F2
case_images: T2-weighted MRI showed no definite change in the pontine high-signal lesion, and MR spectroscopy revealed no choline elevation (Cho/Cr ratio of 1.13) or NAA reduction (Cho/NAA ratio of 0.56) (Fig. 2A and B, respectively). Perfusion MRI showed no definite relative cerebral blood volume increase (Fig. 2C), and 18FDG PET showed no hypermetabolic lesion (Fig. 2D).
case_images: Gradual regression of the T2 high-intensity lesion was noticed on the 6-month follow-up MRI (A). The lesion became invisible on the 1.5-year follow-up MRI (B) and remained regressed on the recent 6.5-year follow-up MRI (C).
case_images: btrt-12-58-g003.jpg
case_images: PMC10864136_01_btrt-12-58-g003.jpg
case_images: F3