PMC8053428_01
Pre- and posttreatment T1 gadolinium-enhanced MRI brain. A pretreatment T1-gadolinium enhanced MRI brain. Contrast-enhancing lesions are shown in the right temporal lobe (a - arrow), thalamus (b - arrowhead), and frontal lobe (c - block arrow).
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F1
MRI brain showed three contrast-enhancing lesions: 14 x 6 mm right posterior temporal lesion, 7 x 5 mm posteromedial right thalamic lesion, and 3 mm subcortical posterior right frontal lobe lesion [Figures 1a-c].
Pretreatment PET scan and MRI femur. There are hypermetabolic lesions of the left femur (block/black arrow) and vastus lateralis (arrow) (a and b). No radiotracer uptake is noted within the lungs (a). MRI femur depicted a 4.2 cm x 4.1 cm vastus lateralos lesion (c) which, following 7 atezolizumab cycles, regressed to 2.3 cm x 2.1 cm (d).
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F2
Following soft-tissue biopsy, PET scan showed pathologic radiotracer uptake in the left femur without radiotracer uptake in the lungs [Figures 2a and b]. Following 7 cycles, repeat MRI femur showed a PR of the primary lesion from 4.2 x 4.1 cm to 2.3 x 2.1 cm (RECIST 1.1) [Figures 2c and  d]. PET imaging [Figure 2b]. Pathology noted 75% necrosis/ fibrosis in the primary lesion and CR of the femoral metastasis.
Eleven-month posttreatment T1 gadolinium-enhanced MRI brain. An eleven-month postoperatively MRI. The temporal lesion has not recurred (a) with near complete response of the thalamic lesion (b - arrowhead) and stable frontal lesion (c - block arrow).
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F3
Review of CT chest, MRI brain, and CT femur shows no recurrence of the left lower extremity disease or the dominant right posterior temporal lesion [Figure 3a]. A faint linear enhancing focus remains at the posterior aspect of the right thalamus [Figure 3b] and the posterior right frontal lobe lesion has decreased in size from 4 mm to 3 mm [Figure 3c], with unchanged peritumoral edema. No new appreciable lesions were noted [Figures 3a-c].