case_images: PMC11101927_01
case_images: (A) T1WI, (B) T2WI, (C) FLAIR, (D) DIR, (E) T1WI-CHESS, (F) interictal FDG-PET MRI fusion image, and (G) subtraction ictal SPECT co-registered to MRI. The right medial frontal lobe showed subtle cortical thickening and blurring of gray/white matter boundaries on T1WI /T2WI/FLAIR/DIR, without signal abnormality (arrows, A-D). However, T1WI-CHESS detected a subcortical linear high signal along the affected gyri (arrows, E). Interictal FDG-PET showed a slightly decreased accumulation consistent with the lesion, compared to the opposite cortex (arrow, F). Subtraction ictal SPECT co-registered to MRI indicated increased blood flow in the lesion (arrows, G). CHESS: chemical shift selective, DIR: double inversion recovery, FDG: fluorodeoxyglucose, FLAIR: fluid-attenuated inversion recovery, PET: positron emission tomography, SPECT: single photon emission computed tomography.
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case_images: T1WI/T2WI/fluid-attenuated inversion recovery (FLAIR)/double inversion recovery (DIR) imaging demonstrated subtle cortical thickening and blurring of gray/white matter boundaries in the right medial frontal lobe, a weak subcortical high signal in the right superior frontal gyrus, and decreased white matter volume in the right central posterior gyrus (Fig. 1A-D, Fig. 2A-D). However, T1WI-CHESS detected a subcortical linear high signal along the affected medial frontal and postcentral gyri (Fig. 1E, Fig. 2E). In some parts of the affected areas, a slight decrease in accumulation on interictal fluorodeoxyglucose-positron emission tomography (FDG-PET) and increased blood flow on subtraction ictal single photon emission computed tomography (SPECT) co-registered to MRI were observed (Fig. 1F, G).
case_images: The histopathological specimens shown here are the parts of the lesion indicated in Fig. 2. (A) Kluver-Barrera (KB), (B) hematoxylin and eosin-stained (H&E), (C) enlarged image of the marked area in panel B, (D) H&E, (E) myelin basic protein (MBP), (F) oligodendrocyte transcription factor 2 (Olig2), (G) neuronal nuclear protein (NeuN), and (H) MIB-1 in the anterior of right superior frontal gyrus. KB staining showed partial blurring of gray/white matter boundaries (arrows, A). B: H&E staining showed a focal increase in cell density at the gray/white matter boundaries. C: High-power magnification of the H&E image showed increased oligodendroglia and neurons. E-G: Immunohistochemical staining of the same area as the gray/white matter boundaries (D); MBP staining showed patchy loss (E), and Olig2- and NeuN-positive cells showed a heterogeneous increase (F, G). The MIB-1 positivity rate was low. Scale bar = 500 microm (A), 100 microm (B, H), 50 microm (C), and 200 microm (D-G).
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case_images: The MIB-1 positivity rate was low (Fig. 3).