case_images: PMC6742723_01
case_images: MRI in November 2013. An abnormal signal was confined to left frontal lobe. It was not obvious on the T1-weighted image (A) and hyperintense on the T2-weighted-Fluid-Attenuated Inversion Recovery (T2-FLAIR) image (B) in the absence of enhancement (C). The T2-weighted image was unavailable.
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case_images: F1
case_images: In November 2013, he underwent a magnetic resonance imaging (MRI) scan that was unremarkable, except for the presence of small patchy areas in the left frontal lobe (Figure 1).
case_images: MRI in October 2017. There was a cystic lesion in the left frontal lobe that presented as hypointense on the T1-weighted image (A), hyperintense on the T2/T2-FLAIR/Apparent diffusion coefficient (ADC) image (B,C,E) and hypointense on the diffusion weighted imaging (DWI, D), with surrounding edema and rim enhancement (F).
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case_images: F2
case_images: He underwent another MRI scan, revealing a cystic lesion with rim enhancement at the same location (Figure 2).
case_images: Fluorodeoxyglucose-positron emission tomography-computed tomography (FDG-PET-CT) in October 2017. FDG-PET-CT indicated low glucose metabolism of left frontal-parietal lobe, which was suggestive of an intracranial primary benign lesion.
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case_images: F3
case_images: Fluorodeoxyglucose-positron emission tomography-computed tomography (FDG-PET-CT) showed low metabolism (Figure 3), and coupled with the patient's raw food diet, a diagnosis of parasitosis was made.
case_images: MRI in September 2018. The cystic lesion in left frontal lobe was enlarged. The lesion showed the same characteristics as the MRI scan performed in 2017. [(A-F) Represents T2-weighted image, FLAIR, DWI, ADC, axial and sagittal post-contrast T1-weighted image, respectively. The pre-contrast T1-weighted image was unavailable].
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case_images: F4
case_images: MRI scan revealed further enlargement of the lesion (Figure 4), and magnetic resonance spectroscopy (MRS, Figure 5A) and diffusion tensor imaging (DTI, Figure 5B) were scheduled. MRS detected a significantly heightened choline (Cho) peak and a weakened N-acetylaspartate (NAA) peak.
case_images: (A) Magnetic resonance spectroscopy (MRS) in September 2018. MRS of peri-enhancement area detected a significantly heightened choline (Cho) peak at 3.2 ppm, and a weakened N-acetylaspartate (NAA) peak at 2.0 ppm. Resonance peak integral of Cho and NAA were 1.96 and 0.40, respectively. The Cho/NAA ratio was 4.9. (B) Diffusion tensor imaging (DTI) in September 2018. Three-dimensional reconstruction images showed an invasion of the lesion into the left pyramidal tract.
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case_images: F5
case_images: MRI scan revealed further enlargement of the lesion (Figure 4), and magnetic resonance spectroscopy (MRS, Figure 5A) and diffusion tensor imaging (DTI, Figure 5B) were scheduled. MRS detected a significantly heightened choline (Cho) peak and a weakened N-acetylaspartate (NAA) peak.
case_images: (A) Use of an intraoperative electrophysiological monitor during surgery. Electrodes were placed on the surface of the brain to identify the functional area. (B) The pale-yellow cystic fluid suctioned by the needle. (C) The cyst wall exposed after removing the cystic fluid. It was soft and dark red in appearance.
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case_images: F6
case_images: We performed lesion resection under an intraoperative electrophysiological monitor to protect the adjoining precentral gyrus (Figure 6A). Beneath the cortex, there was a solid-cystic lesion containing pale-yellow cystic fluid (Figure 6B). The cyst wall was soft and dark red in appearance (Figure 6C).
case_images: Histological analysis. The pathological report gave a diagnosis of glioblastoma, WHO IV, without mutation of the isocitrate dehydrogenase 1 (IDH1) gene.
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case_images: F7
case_images: Health Organization (WHO) Classification of Tumors of the Central Nervous System. Histological analysis showed an absence of mutation of the isocitrate dehydrogenase 1 (IDH1) gene (Figure 7).