case_images: PMC11349654_01
case_images: (A-C) The right temporal lobe showed a nodular which was characterized by hypointensity on T1 and hyperintensity on T2, with significant edema zone. There also showed slightly edema without clear lesion in the left temporal lobe. The cysts didn't suppress on FLAIR. (D) Enhanced axial T1-weighted image showed significant enhancement of lesions in the bilateral temporal lobes. The adjacent meninges were enhanced, with a characteristic "dural tail". (E-H) DCE parameters analyzed based on the Tofts model: Ktrans, Kep, Ve and iAUC.
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case_images: PMC11349654_01_fnins-18-1442176-g001.jpg
case_images: F1
case_images: The routine MRI (Figures 1A-D, 2) revealed a nodule (15 x 14 x 12mm) in the right temporal lobe accompanied by surrounding brain tissue edema, presenting as hypointensity on T1WI, hyperintensity on T2WI, and no restricted diffusion on diffusion-weighted imaging. The mean Ktrans, Kep and iAUC in the right lesion were lower than in the contralateral area (Figures 1E-H and Table 1).
case_images: (H) Conventional Diffusion-Weighted Imaging (DWI) (b = 1000) shows the lesion with iso-signal. (A) F map, (B) D map, (C) D map, (D) rBF map from intravoxel incoherent motion (IVIM) image. (E) DDC map, (F) alpha map, (G) sADC map from stretched exponential model (SEM) image.
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case_images: F2
case_images: The routine MRI (Figures 1A-D, 2) revealed a nodule (15 x 14 x 12mm) in the right temporal lobe accompanied by surrounding brain tissue edema, presenting as hypointensity on T1WI, hyperintensity on T2WI, and no restricted diffusion on diffusion-weighted imaging. With SEM and IVIM imaging, the mean parameters of the nodule in the right temporal lobe were higher than those in normal brain tissue, except for the mean f (Figure 2 and Table 2).
case_images: (A) Amide proton transfer-weighted imaging shows increased signal on the right side of the lesion, while the signal on the left lesion is consistent with normal brain tissue. (B) Positioning image of single-voxel magnetic resonance (MR) spectroscopy. (C) Magnetic Resonance Spectroscopy Imaging shows a high Cho peak, a low Cr and NAA peak, Cho/NAA ratio greater than 1, and a negative Lip and Lac peak was observed at 1.33 ppm.
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case_images: F3
case_images: MR spectroscopy (Figure 3) revealed a slight increase choline (Cho) peak and a slight decrease in the peaks of creatine (Cr) and N-acetylaspartate (NAA). Cho/Cr ratio was 1.31 while Cho/NAA ratio was 1.72. CEST imaging (Figure 3) indicated a higher signal in the larger lesion on the right compared to the signal in normal brain tissue.
case_images: Postoperative pathology reveals fibrous tissue proliferation accompanied by numerous lymphocytes and plasma cells, scattered focally within granulomatous-like structures. Endothelial cell proliferation is observed in small arteries within the lesion, leading to luminal narrowing/solidification. Lymphoplasmacytic infiltration surrounds the vascular walls, histologically consistent with an inflammatory process.
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case_images: PMC11349654_01_fnins-18-1442176-g004.jpg
case_images: F4
case_images: The postoperative pathological results (Figure 4) revealed granulomatous structures accompanied by fibrous tissue proliferation, surrounded by lymphocytes and plasma cells.