PMC5570115_01
A, C, E, G, Axial fluid attenuation inversion recovery (FLAIR). B, A coronal T2-weighted image. D, F, and H, contrast-enhanced coronal T1-weighted magnetic resonance (MR) images. At the age of 3.6 years, multiple cortical/subcortical FLAIR hyperintense tubers within the bilateral frontal and parietal lobes (A) as well as a well-circumscribed, T2-isointense subependymal nodule at the level of right foramen Monro (B, arrow) are seen. At the age of 5.1 years, some of the tubers show calcifications (FLAIR hypointense, C) and there is an increase in size of the enhancing subependymal giant cell astrocytoma subependymal giant cell astrocytoma (SEGA) at the level of right foramen Monro (D, arrow). At the age of 6.1 years, unchanged cortical/subcortical tubers (E) and mild increase in size of the SEGA (F, arrow) are noted. At the age of 6.8 years, stable cortical/subcortical tubers (G) and stabilization of the SEGA (H, arrow) are seen.
10.1177_2329048X17725609-fig2.jpg
PMC5570115_01_10.1177_2329048X17725609-fig2.jpg
fig2-2329048X17725609
Subependymal nodules were also observed in both lateral ventricles; the largest was at the level of the right foramen of Monro measuring 6 mm x 8 mm (Figure 2A and B). In July 2013 (aged 5 years), MRI revealed growth of the right subependymal nodule to 7 mm x 10 mm in cross-sectional dimensions, but without ventriculomegaly (Figure 2C and D). Upon routine follow-up 1 year later (August 2014), MRI revealed slow growth of the right subependymal nodule, which was then classified as a subependymal giant cell astrocytoma (7 mm x 11 mm in cross-sectional dimensions; Figure 2E and F). The most recent brain MRI showed no change in the subependymal giant cell astrocytoma compared with 8 months earlier (Figure 2G and H), abdominal MRI appeared normal, and liver angiomyolipoma was not visualized on ultrasound.