PMC6443873_01
MRI image of progression of left temporoparietal metastasis. Contrast enhanced T1 MRI showing a 1.6 cm left temporoparietal lesion that increased in size after completion of whole brain radiation. This lesion was treated subsequently with stereotactic radiosurgery.
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F1
However, MRI brain showed a solitary 1.6 cm left temporoparietal lesion (Figure 1).
MRI images of ependymal disease and response to whole brain re-irradiation. (A) Contrast enhanced T1 MRI showing new enhancing, linear, and nodular lesions along the ventricles consistent with ependymal disease. (B) Contrast enhanced T1 MRI performed 2 months after whole brain re-irradiation showing a significant and rapid decrease in ependymal enhancement. The treated metastasis in the left temporoparietal area was stable. (C) Contrast enhanced T1 MRI performed 1 year after whole brain radiation showing resolution of nodular lesions along the ventricles and no new brain metastases.
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F2
On workup for this procedure, she was found to have progression of brain metastases including a new 3 mm enhancing focus involving the right anterior body of corpus callosum and enhancing, linear and nodular lesions along the ventricles consistent with ependymal spread (Figure 2A). MRI 2 months post-WBRT showed a decrease in ependymal enhancement; the previously treated metastasis was stable (Figure 2B). Her last follow up brain MRI showed slight increase size of the left parietal radiation necrosis, but her ependymal disease was stable and there were no new lesions (Figure 2C).