PMC7365899_01
Sagittal spin-echo (SE) T1-weighted (T1w) acquired after i.v. administration of gadolinium (+Gd) demonstrating a solid enhancing mass (arrow) that extends from the pituitary fossa to the chiasmatic cistern displacing the optic chiasm.
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In August 2005 a pituitary MRI showed the presence of a solid enhancing mass extending to the suprasellar region (at that time a 0,5 T GE Vectra was used; see Fig. 1).
Sagittal fast-spin-echo (FSE) T1w + Gd acquired in 2017 after the second surgical treatment. Findings are compatible with the result of the trans-nasal surgical excision (dotted line) with no evidence of pathological tissue outside the pituitary fossa.
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In the following two years after surgery, the neuroimaging findings (thereafter a GE Signa HD 1.5 T was used) were stable with no signs of disease recurrence (Fig. 2).
3D Sagittal fast spoiled gradient-echo (FSPGR) T1w + Gd from 2018 showing a small token of pathological tissue along the petroclival profile (arrow) misdiagnosed as radiation induced meningioma.
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A control MRI showed partial regression of the parasellar lesion, but revealed a focal thickening along the petroclival profile and the tentorial surface, wrongly interpreted as radiation-induced meningioma (Fig. 3).
Sagittal FSE T1w + Gd from 2019 showing increased volume of the previously reported tissue along the petroclival profile (asterisk) which is now characterized by an intralesional necrotic-cystic degeneration area (arrow).
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On subsequent follow-ups (January and April 2019) a progressive growth of the petroclival tissue was reported, with the onset of intralesional necrotic-cystic degeneration areas (Fig. 4).
Sagittal FSE T1w + Gd of the lumbar spine from September 2019 showing multiple intraspecal round dural solid lesions consistent with drop metastasis (arrows). The largest is at the L3 level and also show areas of necrotic-cystic degeneration as the tissue described along the petroclival profile (see Fig. 4).
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A lumbar MRI showed three intraspecal rounded lesions consistent with drop metastases or multiple schwannomas; the largest at the L3 level presented areas of necrotic-cystic degeneration similar to those described in the petroclival region (Fig. 5). An FDG-PET scan (GE PET-CT Discovery 690), detected hypercaptation of the radiotracer in the retroclival region and in the intraspecal space at the L3 level (Fig. 6).
FDG-PET examination (sagittal multiplanar reconstruction, MPR) from October 2019 showing the radio tracer uptake only in the retroclival region and in the intraspecal space at the L3 level.
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A lumbar MRI showed three intraspecal rounded lesions consistent with drop metastases or multiple schwannomas; the largest at the L3 level presented areas of necrotic-cystic degeneration similar to those described in the petroclival region (Fig. 5). An FDG-PET scan (GE PET-CT Discovery 690), detected hypercaptation of the radiotracer in the retroclival region and in the intraspecal space at the L3 level (Fig. 6).
Sagittal Fluid Attenuated Inversion Recovery (FLAIR) T1w + Gd from February 2020 that reveals a huge increase of the heterogeneous petroclival tissue obliterating periaxial cisterns with mass effect on the brainstem. A dural metastasis is also appreciable (arrow).
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MRI revealed a huge increase in volume of the heterogeneous petroclival and parasellar tissue, extending down to the atlanto-occipital joint, obliterating the foramen magnum and the interpeduncular-prepontine cisterns, with compressive effect on the brainstem and fourth ventricle (Fig.7). Multiple small solid lesions strictly connected with the tentorial cerebellar surface (Fig. 8) were also demonstrated.
Axial MPR from 3D Sagittal FSPGR T1w + Gd from February 2020 revealing multiple small solid enhancing lesions consistent with dural metastasis strictly connected with tentorium cerebelli.
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MRI revealed a huge increase in volume of the heterogeneous petroclival and parasellar tissue, extending down to the atlanto-occipital joint, obliterating the foramen magnum and the interpeduncular-prepontine cisterns, with compressive effect on the brainstem and fourth ventricle (Fig.7). Multiple small solid lesions strictly connected with the tentorial cerebellar surface (Fig. 8) were also demonstrated.