PMC5460377_01
X-ray of both knees in anteroposterior view showing bilateral patchy high density donating sclerosis affecting the metaphysis of the distal femur and the proximal tibia bilaterally.
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fig1
Plain X-ray of both knees showed multiple sclerotic patches of the distal femur and upper parts of both tibiae (Figure 1) while bilateral tibia magnetic resonance imaging (MRI) showed bilateral lesions replacing the normal fatty signal intensity in the T1 weighted images (Figure 2).
Bilateral tibial coronal T1 MRI showed bilateral asymmetrical hypointense lesions replacing the normal fatty signal intensity of both tibiae as compared to the normally appearing marrow fat signal in the talus. Note also the cortical thickening noted in the tibial cortices medially (arrows).
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fig2
Plain X-ray of both knees showed multiple sclerotic patches of the distal femur and upper parts of both tibiae (Figure 1) while bilateral tibia magnetic resonance imaging (MRI) showed bilateral lesions replacing the normal fatty signal intensity in the T1 weighted images (Figure 2).
Contrast enhanced coronal T1 weighted image of the brain showing bilateral well-defined enhancing lesions in the temporal poles located laterally to the amygdala (bold arrows).
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fig3
Initial brain MRI showed bilateral well-defined round intensely enhancing lesions located in the temporal poles lateral to the amygdala and anterior to the temporal horns with thickened enhanced pituitary stalk (Figure 3), in conjunction with partially empty sella and absent bright signal of the neurohypophysis (Figure 4).
Postcontrast axial T1 weighted images of the brain at the level of the orbits showing the thickened enhanced pituitary stalk (arrow head) almost reaching the same size of the enhanced basilar artery. Note also the enhancing bilateral lesions anterior to the amygdala.
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fig4
Initial brain MRI showed bilateral well-defined round intensely enhancing lesions located in the temporal poles lateral to the amygdala and anterior to the temporal horns with thickened enhanced pituitary stalk (Figure 3), in conjunction with partially empty sella and absent bright signal of the neurohypophysis (Figure 4).
(a) FDG PET scan coronal reformate showing increased FDG uptake in temporal lobes, facial bones, radius, ulna, and distal femora. (b) FDG PET scan coronal reformatted images for the tibia showing bilateral increased FDG uptake in distal femora and tibiae.
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fig5
Whole body positron emission tomography (PET) scan showed increased FDG uptake in temporal lobes and facial and long bones (Figures 5(a) and 5(b)).
Axial contrast enhanced T1 weighted image of the brain showing increased outward convexity due to enhancing lesion in the left cavernous sinus (arrow) encasing the left internal carotid artery; however, it remained patent.
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fig6
Brain MRI showed new enhancing lesion in the vicinity of the left cavernous sinus (Figure 6), with pachymeningeal thickening along the tentorial leaflets and interval regression of the mesial temporal lobe lesions.