PMC4533502_01
Axial magnetic resonance (MR) images obtained at 24 months after onset. A: A negative diffusion-weighted image indicating denial of brain abscess. B: T2-weighted image show marked brain edema around the lesion. C: Nonenhanced T1-weighted image show isointensity lesion partly surrounded by high-intensity rim, suggesting minor hemorrhage. D: Post-gadolinium T1-weighted image show ring-shaped enhancement, indicating a hemorrhagic tumor. T1-weighted images without (E) and with (F) gadolinium injection at the level of lateral ventricles showing non-existence of tumor.
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F1
On examination, he was alert but had minor left hemiparesis and brain magnetic resonance (MR) imaging revealed a ring-shaped enhancing mass (14 x 14 x 15 mm), but negative in diffusion-weighted image with prominent edema in the right precentral gyrus (Fig. 1).
Axial T1-weighted magnetic resonance images at 26 months after onset without (A) and with (B) gadolinium injection demonstrating disappearance of the enhancing tumor.
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F2
Radiological examination confirmed the remarkable shrinkage of the enhanced lesion and surrounding edema (Fig. 2).
Axial T1-weighted magnetic resonance images at 28 months after onset without (A) and with (B) gadolinium injection demonstrating new ring-shaped enhancing lesion on the wall of right lateral ventricle. C: T2-weighted image show a lesion at the same portion of ring-shaped enhancement surrounded by edema. The relatively wide expansion of edema compared with the lesion suggest metastatic tumor.
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F3
Although he was symptom-free, a follow-up brain MR imaging study at 28 months after onset revealed emergence of a new lesion on the wall of right lateral ventricle with the size of 8 x 6 x 8 mm (Fig. 3), so that sunitinib dose was increased to 37.5 mg.
Axial T1-weighted images at 34 months after onset without (A, B) and with (C, D) gadolinium injection showing no evidence of remaining tumors.
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F4
Subsequently the second lesion disappeared and no other new metastasis was detected by repeated MR images for 9 months from initiation of sunitinib (Fig. 4) and he is doing well, taking 25 mg sunitinib continuously on schedule 4/2 without any symptoms.