PMC5364933_01
Preoperative axial T2- (A) and axial T1-weighted magnetic resonance imaging (MRI) with gadolinium enhancement (B) show a high-intensity area around the resection cavity of the first surgery and enhanced areas (arrow) inside the mass lesion, respectively. (C) L-[methyl-11C] methionine (11C-MET) positron emission tomography (PET) clearly shows relatively regular high uptake inside the superficial and medial parts of the lesion (arrowhead).
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F1
An MRI study confirmed the presence of a well-defined area of high intensity on T2-weighted images, and the area contacted the margin of the right precentral gyrus (Fig. 1A). T1-weighted MRI with gadolinium enhancement (arrow in Fig. 1B). The area with the highest uptake in a positron emission tomography (PET) scan with L-[methyl-11C] methionine (11C-MET) was in the superficial and medial part of the lesion (arrowhead in Fig. 1C), which corresponded largely with the enhanced area that was seen on MRI.
Intraoperative photograph taken after tumor resection and placement of the Gliadel wafers. The Gliadel wafers (**) were implanted on the precentral gyrus and anterior side of the pyramidal tract (*).
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F2
Therefore, five Gliadel wafers were implanted on the precentral gyrus and anterior side of the pyramidal tract because we concluded that further resection of these areas would not be possible if tumor recurrence occurred (Fig. 2).
Postoperative day 4 axial T2-weighted magnetic resonance imaging (MRI) scans (A) show localized high intensity areas along the pyramidal tracts where Gliadel wafers were placed and a very low-intensity area (arrowhead) that was suspected to be Gliadel wafers. Postoperative day 4 diffusion-weighted MRI scans (B) and T1-weighted MRI with gadolinium enhancement (C) show areas of high intensity in the anterior part of the right precentral gyrus.
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F3
Postoperative MRI showed that localized areas of high intensity on T2-weighted images appeared along the pyramidal tracts where the Gliadel wafers had been placed (Fig. 3A). Because these areas did not exhibit high intensity on diffusion-weighted MRI scans (Fig. 3B), focal edema was strongly suspected to have been directly caused by the Gliadel wafer placement and not by ischemic changes resulting from the surgical procedure. On postsurgical MRIs that were performed on postoperative days 4, 20, 29, 36, and 47 (Figs. 3, 4), the focal edema that was localized to the precentral gyrus reduced gradually.
Postoperative axial T2-weighted magnetic resonance imaging (MRI) scans and T1-weighted MRI with gadolinium enhancement performed on day 20 (A, E), day 29 (B, F), day 36 (C, G), and day 47 (D, H). The high-intensity area of T2-weighted images in the right precentral gyrus gradually reduced and disappeared on day 47. T1-weighted MRI with gadolinium enhancement show that enhancing areas also gradually reduced through the postoperative course.
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F4
On postsurgical MRIs that were performed on postoperative days 4, 20, 29, 36, and 47 (Figs. 3, 4), the focal edema that was localized to the precentral gyrus reduced gradually.