PMC9465085_01
Part 1: (A,B) Axial T2 FLAIR-weighted images demonstrated extensive, asymmetric involvement of periventricular and deep white matter [arrows in (A)]. Smaller lesions were observed in the ponto-mesencephalic tegmentum, superior and middle cerebellar peduncles [arrows in (B)]. (C) Lesions were mildly hyperintense on ADC cartography, revealing increased diffusivity (*). (D) A small focus of contrast enhancement was demonstrated in the left superior cerebellar peduncle (arrow). Part 2: (A-C) Reformatted coronal (A) and axial (B) T2 FLAIR-weighted images and sagittal T2-weighted images and sagittal T2 weighted image (C) reveal multiple short-segment hyperintensities (arrows). Lesions are asymmetric and excentrically located and involve both white and gray matter. Signal intensity is variable, from midly to markedly increased. (D) Sagittal post-gadolinium T1-weighted image shows scattered foci of enhancement (arrows). Part 3: (A-C) Sagittal T2 (A) and post-contrast sagittal (B) and axial (C) T1-weighted images demonstrate progression of disease. We found lesions on the entire spinal cord. FLAIR, fluid attenuated inversion recovery; ADC, apparent diffusion coefficient.
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F1
An MRI of the brain was obtained and revealed large, ill-defined T2 fluid attenuated inversion recovery (FLAIR) hyperintensities of periventricular and deep white matter, along with smaller lesions infratentorially (Figure 1, part1). T2 signal intensity and contrast enhancement (Figure 1, part 2). The spinal cord was moderately swollen. Six weeks afterwards, on July 14, an MRI showed an increase in the number and size of spinal cord lesions and the appearance of new foci of contrast enhancement (Figure 1, part 3).
(A) sagittal view of FDG-PET/CT showing hypermetabolism of the spinal cord at the cervicothoracic level (between arrows). (B) sagittal view of FDG-PET/CT showing hypermetabolism of the spinal cord at the lumbosacral level (black arrow) and an interspinous hypermetabolism at two level of the lumbar spine (open arrows). (C) fused FDG-PET/CT image on the transverse plane showing a marked and diffuse hypermetabolism of the thyroid gland. FDG-PET/CT, whole body 19-fluorodeoxyglucose positron emission tomography with computed tomography.
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F2
T2 signal intensity and contrast enhancement (Figure 1, part 2). The spinal cord was moderately swollen. Results revealed increased glucose uptake not only in the spinal cord but also in the thyroid, the thoracic aorta walls and the lumbar spinous processes (Figure 2).