case_images: PMC11832352_01
case_images: Imaging from presentation with T1 sequence on (A1-A3) demonstrating a hyperintense ring-enhancing lesion in the left frontal-parietal region. Postoperative imaging, day 7 after diagnosis, with T1 sequence on (B1-B3) demonstrating postoperative changes. RT plan 1 (RT1) utilizing a noncontrast computed tomography (CT) with dose color outline. First course of RT (C1-C3) (red is 40.05 Gy, purple is 43.25 Gy, pink 41.65 Gy, light green 38.05 Gy, yellow is 36.05 Gy, blue is 32.04 Gy, orange is 25.00 Gy, light blue is 20.00 Gy, dark green is 15.00 Gy, and light pink is 10.00 Gy). Column 1 is a coronal section through the body of caudate and anterior cerebellum, column 2 is a sagittal section through the left superficial temporal and parietal lobe, and column 3 is an axial section through superior cerebrum and lateral ventricles.
case_images: fonc-15-1501466-g002.jpg
case_images: PMC11832352_01_fonc-15-1501466-g002.jpg
case_images: f2
case_images: Magnetic resonance imaging (MRI) of the brain T1 post-contrast revealed a 3.3 x 2.8 x 2.8-cm enhancing mass in the left frontal-parietal region and a second extra-axial contrast-enhancing lesion in the right occipital lobe with imaging features consistent with a meningioma ( Figures 2A1-3 ).
case_images: Imaging with T1 sequencing 1-month post-RT1, (A1) (axial through intraparietal sulcus), and 28 months post-radiation course 1, (A2) (axial through superior lateral ventricles). Reirradiation utilizing a noncontrast computed tomography (CT) with dose color outline and brain contoured as lavender, (B1-B3) (red is 35.00 Gy, purple is 38.50 Gy, pink 36.75 Gy, light green 33.25 Gy, yellow is 31.50 Gy, blue is 28.00 Gy, orange is 22.75 Gy, light blue is 17.50 Gy, dark green is 10.50 Gy, and light pink is 5.25 Gy). Imaging with T1 sequencing 2 months post-reirradiation, (C1) (axial through superior lateral ventricles). Imaging with T1 sequencing 8 months post-RT2, (C2) (axial through intraparietal sulcus).
case_images: fonc-15-1501466-g003.jpg
case_images: PMC11832352_01_fonc-15-1501466-g003.jpg
case_images: f3
case_images: Magnetic resonance imaging (MRI) of the brain T1 post-contrast revealed a 3.3 x 2.8 x 2.8-cm enhancing mass in the left frontal-parietal region and a second extra-axial contrast-enhancing lesion in the right occipital lobe with imaging features consistent with a meningioma ( Figures 2A1-3 ). The image findings at 4 weeks post-RT were discussed at a multidisciplinary tumor board and were felt to likely be treatment-related as her tumor was methylated ( Figure 3A1 ). At 1 month later, on day 951, MRI of the brain showed a marked progression in the parietal lobe within the previous radiation field ( Figure 3A2 ). Reirradiation of 35 Gy in 10 fractions ( Figures 3B1-3 ) was the selected fractionation for her second RT course. T2 hyperintense signal surrounding the margins of the resection cavity, and expansile T2 hyperintense signal involving the left thalamus that appeared worsened compared to prior imaging. The follow-up imaging was stable until day 1,235 when there was a concern for local recurrent disease versus treatment-related changes from RT ( Figure 3C2 ).