PMC10072189_01
PMC10072189_02
PMC10072189_03
(A) MR AX T1 Flair on 3/13/2020 showing multilobulated mass along left parietal/occipital lobes and extracranial mass. (B) MR SAG T1 Flair on 3/13/2020 showing multilobulated mass along left parietal/occipital lobes and extracranial mass. (C) MR COR T1 Flair on 3/13/2020 showing multilobulated mass along left parietal/occipital lobes. (D) MR AX T1 Flair post-contrast on 03/13/2020 shows new frontal lesion. (E) MR SAG T1 Flair post-contrast on 03/13/2020 shows new frontal lesion.
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F1
Magnetic resonance (MR) imaging identified the new, multilobulated mass as consistent with meningioma, with broad-based dural attachment (Figure 1A-C). MRI additionally revealed a second, smaller mass along the left frontal convexity (Figure 1D-F), measuring 2.5 x 1.0 x 2.0 cm.
(A) MR SAG T1 Flair post-contrast on 10/10/2020 shows the parafalcine lesion. (B) MR COR T1 Flair post-contrast on 10/10/2020 shows growth of parafalcine lesion and invasion into superior sagittal sinus. (C) MR AX T1 Flair post-contrast on 10/10/2020 shows the parafalcine and frontal lesion. (D) MR SAG T1 Flair post-contrast on 10/10/2020 shows the increase in size of the frontal lesion. (E) MR COR T1 Flair post-contrast on 10/10/2020 shows the increase in size of the frontal lesion.
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F2
Despite 2 sessions of Gamma Knife Radiation Surgery to the small frontal lesion and residual left parafalcine lesion, by the end of 2020 the left parafalcine lesion invaded the superior sagittal sinus (SSS), and the frontal lesion increased in size (Figure 2A-E).
PMC10072189_04
(A) MR on 09/08/2021 shows liver metastasis. (B) MR on 09/08/2021 shows kidney metastasis. (C) MR on 09/08/2021 shows spinal metastasis. (D) DOTATE PET on 09/10/2021 shows liver metastases. (E) DOTATE PET on 09/10/2021 shows sacral and vertebral metastases.
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F3
MRI confirmed metastatic lesions in the liver (Figure 3A), left kidney (Figure 3B), and vertebral skeleton (Figure 3C), as well as corresponding DOTATE positron emission tomography (PET) scans (Figure 3D and E).