case_images: PMC11784624_01
case_images: Imaging findings on presentation. (Left) Computed tomography of the brain without contrast showed a destructive lesion (wide arrows) centered in the right frontal bone with associated intracranial and extracranial extensions. The intracranial dural-based component measured 4.9 x 3.2 cm, and the extracranial component measured 4.9 x 1.3 cm. There was a leftward midline shift of 6 mm due to mass effect. (Middle) Magnetic resonance imaging with gadolinium confirmed the right frontal lesion (wide arrows), which exhibited intense enhancement. (Right) Magnetic resonance imaging T2 fluid-attenuated inversion recovery protocol revealed a second lesion in the right occipital bone, which measured 1.5 cm (thin arrows).
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case_images: Computed tomography (CT) of the brain showed a destructive lesion in the right frontal bone, with intracranial dural-based component measuring 4.9 cm and extracranial extension measuring 4.9 cm, associated edema, and 6-mm leftward midline shift (Fig. 1). Brain magnetic resonance imaging (MRI) showed intense enhancement of the right frontal lesion and revealed a 1.5-cm right occipital calvarial lesion (Fig. 1).
case_images: Magnetic resonance imaging findings 3 months after the resection of the right frontal lesion. (Left) The right frontal lesion was no longer seen. (Right) The right occipital bone lesion persisted but remained unchanged in size (thin arrows).
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case_images: Postoperative imaging at 3 to 4 months showed no evidence of residual tumor at the surgical site on brain MRI (Fig. 2), and 18F-FDG positron emission tomography (PET) showed widespread bony metastases, including the occipital lesion (Fig. 3).
case_images: Dodecane tetraacetic acid-octreotate (DOTATATE) positron emission tomography (PET) 7 months after resection confirmed extensive bony metastases, including the lesion in the right occipital bone and a prevertebral lesion (arrows). In addition, the DOTATATE-PET showed additional lesions (arrowheads) that were not obvious on the fluorodeoxyglucose PET, which was likely due to the superior sensitivity of DOTATATE-PET rather than true new lesions.
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case_images: Gallium-68 dodecane tetraacetic acid-octreotate (68Ga-DOTATATE) PET/CT at 7 months confirmed uptake at the known metastatic sites (Fig. 4).