PMC5671500_01
Serial brain magnetic resonance imaging (MRI) of case 1. Initial brain MRI (A) showed a high signal in diffusion-weighted imaging (DWI) at the anterior pons (arrow head) with a low signal in apparent diffusion coefficient (ADC) mapping (white arrow), hyperintensities in fluid attenuation inversion recovery (FLAIR) imaging (black arrow), and no enhancement in T1-weighted imaging with contrast (T1 C). Brain MRI 4 months later (B) and 7 months later (C) showed a thickening of the anterior pons lesion in the FLAIR imaging (black arrow), but gradual resolution of the restricted diffusion pattern in DWI (arrow head) and ADC mapping (white arrow).
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F1
Brain MRI showed a non-enhanced band-like lesion along the anterior surface of the middle cerebellar peduncle, pons, and medulla with a high signal on fluid attenuation inversion recovery (FLAIR) imaging, and a restricted diffusion pattern on diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) mapping (Figure 1). Follow-up brain MRI after 3 months showed persistent hyperintensity on FLAIR imaging but regression of restricted diffusion of the anterior brainstem lesions (Figure 1).
Brain magnetic resonance imaging of case 2, 3, and 4. A high signal in diffusion-weighted imaging (DWI) at the lower pons level (arrow head) and upper pons level (white arrow) with a corresponding low signal on apparent diffusion coefficient (ADC) mapping and hyperintensities on fluid attenuation inversion recovery (FLAIR) imaging (black arrow) in case 2 (A), case 3 (B), and case 4 (C).
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F2
Brain MRI showed parenchymal metastasis at the left cerebellum and a non-enhanced symmetric band-like anterior brainstem lesion with a restricted diffusion pattern (Figure 2). Brain MRI showed non-enhanced symmetric band-like anterior brainstem lesions with restricted diffusion (Figure 2). Follow-up brain MRI showed the disappearance of almost all of the enhancing nodules, but also revealed newly developed restricted diffusion lesions at the anterior brainstem and bilateral corona radiata (Figure 2).