PMC6304209_01
Initial imaging findings. (a) Axial fluid attenuation inversion recovery (FLAIR) image reveals a large hyperintense lesion in the left frontal lobe with surrounding vasogenic edema. (b) Axial FLAIR image shows hyperintense demyelinating lesions in bilateral subcortical white matter. (c) Sagittal T2-weighted image demonstrates T2 hypointense rim (arrow). (d) Sagittal T1-weighted postcontrast image shows ring enhancement.
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fig1
Hyperintense lesions were observed in the subcortical and deep white matter in the right hemisphere on T2-weighted and FLAIR images (Figure 1).
One month later. ((a),(c)) Improvement of the tumefactive lesion is visible in the left frontal lobe and a new tumefactive lesion has appeared in the right frontal white matter. ((b),(d)) T1-weighted postcontrast images show ring enhancement.
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fig2
However, a new tumefactive lesion with perifocal edema, which demonstrated ring-like gadolinium enhancement on T1-weighted images and peripheral restriction on DWI, was observed in the right frontal area (Figure 2).
One year later. (a) Regression of tumefactive lesions is evident. (b) Axial fluid attenuation inversion recovery (FLAIR) image shows new hyperintense lesions in the bilateral parietooccipital white matter. (c) Sagittal FLAIR image demonstrates periventricular, cortical/juxtacortical demyelinating lesions. (d) T1-weighted postcontrast image shows contrast enhancement of the lesion in the left parietooccipital white matter.
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fig3
After gadolinium administration, peripheral contrast enhancement was observed in the lesion on the left side (Figure 3).