PMC9805631_01
Preoperative progression of MRI characteristics. (a) Axial T1 noncontrast, T1 contrast, FLAIR, and sagittal T1 contrast MRI images demonstrate gyral gray matter T1 shortening without contrast enhancement or adjacent edema. No diffusion restriction was present on diffusion-weighted sequences (not shown). (b) Axial T1 noncontrast, T1 contrast, FLAIR, and sagittal T1 contrast MRI images demonstrate interval gyral expansion adjacent to the previously noted T1 shortening, development of surrounding vasogenic edema, and new contrast-enhancing nodule apparent on T1 sagittal postcontrast image.
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F1
Routine, asymptomatic surveillance brain MRI with contrast was obtained and was notable for gyriform T1 shortening in the right pars opercularis, new from most recent imaging performed 23 months prior [Figure 1a]. Repeat MRI obtained 3 months later revealed gyral expansion in the region of the T1 shortening as well as a new contrast-enhancing adjacent nodule with vasogenic edema [Figure 1b].
Intraoperative photograph. Dural leaflets are reflected to reveal a brown-colored melanotic lesion.
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F2
The lesion followed and infiltrated gray matter in a gyriform pattern, with an adjacent melanotic nodule [Figure 2].