PMC5423709_01
Composite fluid-attenuated inverse recovery (FLAIR), T1-weighted post-contrast, and apparent diffusion coefficient (ADC) map images from MRI of Case 1 at initial presentation: (a) FLAIR sequence demonstrates symmetric periventricular T2 signal hyperintensity, (b) T1 post-contrast shows absence of enhancement, and (c) ADC map indicates presence of restricted diffusion (dark signal) within the periventricular white matter corresponding to the distribution of signal alteration on the FLAIR sequence.
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PMC5423709_01_10.1177_2050313X17706875-fig1.jpg
fig1-2050313X17706875
T2 hyperintensity in the bilateral deep white matter on the fluid-attenuated inverse recovery (FLAIR) sequence. These areas did not enhance and demonstrated restricted diffusion on the apparent diffusion coefficient (ADC) map not corresponding to a discrete arterial distribution (Figure 1).
PMC5423709_02
Composite T1-weighted pre-contrast, T1-weighted post-contrast, and apparent diffusion coefficient (ADC) images from MRI of Case 2 at onset of delirium (post MTX therapy): (a) T1-weighted pre-contrast image shows a small area of T1 hyperintense signal with the left basal ganglia (arrow), (b) No significant enhancement on the T1-weighted post-contrast sequence, and (c) ADC map shows restricted diffusion (arrow) at site of T1 hyperintensity in the left basal ganglia.
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PMC5423709_02_10.1177_2050313X17706875-fig2.jpg
fig2-2050313X17706875
A repeat head MRI revealed near-complete interval resolution of the enhancing left basal ganglia mass, but interval development of a small area of restricted diffusion at the site of previous enhancement in the left basal ganglia (Figure 2).