PMC2821649_01
Axial, T1-weighted, postcontrast MR images of the brain. (a) A 2.3 x 2.3 x 2.5 cm left cerebellar lesion occurred synchronous with the diagnosis of a primary NSCLC. (b) The left cerebellar lesion was completely removed through a left suboccipital craniectomy. (c) No residual enhancement is noted after WBRT. (d) There is no evidence of recurrent brain metastasis on MRI obtained 2 years after diagnosis.
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Magnetic resonance imaging (MRI) revealed an enhancing, intra-axial mass in the left cerebellum, measuring 2.3 x 2.3 x 2.5 cm and accompanied by surrounding edema (Figure 1(a)). Postoperative MRI demonstrated gross total resection of the brain metastasis (Figure 1(b)). Given the absence of distant dissemination elsewhere, the control of intracranial disease (Figure 1(c)), and the patient's good KPS, it was decided that aggressive, multimodality therapy would be offered for management of the intrathoracic component of NSCLC. Two years after completion of therapy, whole-body FDG-PET/CT imaging (Figures 2(c) and 2(d) and brain MRI (Figure 1(d)) have demonstrated no evidence of disease.
Coronal views of FDG-PET/CT scan obtained before (a)-(b) and after (c)-(d) treatment for primary NSCLC in patient with synchronous SBM. At diagnosis, the patient demonstrated hypermetabolic activity in a primary LUL tumor with mediastinal (a) and hilar (b)lymphadenopathy. Two years after treatment, including surgical resection, chemotherapy, and mediastinal RT, there is no evidence of hypermetabolic activity at the prior sites of thoracic involvement (c)-(d).
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Staging evaluation was completed with whole-body, 18-fluoro-deoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) imaging, which demonstrated a hypermetabolic left upper lobe tumor and two hypermetabolic foci in the left para-aortic and suprahilar regions (Figures 2(a) and 2(b)). Two years after completion of therapy, whole-body FDG-PET/CT imaging (Figures 2(c) and 2(d) and brain MRI (Figure 1(d)) have demonstrated no evidence of disease.