PMC9659735_01
Initial (A, B) and follow-up (C, D) brain MRIs of the patient. (A) Diffuse leptomeningeal enhancement along the bilateral cerebral sulci without any parenchymal abnormalities on post-contrast T1WI. (B) Diffuse leptomeningeal enhancement predominantly in the left cerebral sulci (arrows) on contrast-enhanced FLAIR sequence. (C) Near-complete resolution of diffuse leptomeningeal enhancement on post-contrast T1WI. (D) Multiple cerebral lesions at the left insular cortex and subcortical white matter of the left frontal and temporal gyri (arrows) on FLAIR sequence. TIWI, T1-weighted imaging; FLAIR, fluid-attenuated inversion recovery.
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T1-weighted imaging ( Figure 1A ). This enhancement pattern was more prominent in the left cerebral sulci on the contrast-enhanced fluid-attenuated inversion recovery (FLAIR) sequence ( Figure 1B ). A follow-up brain MRI was performed after the last dose of rituximab, which indicated near-complete resolution of the diffuse leptomeningeal enhancement ( Figure 1C ). However, new multiple cerebral lesions with hyperintensities appeared on the FLAIR sequence in the left insular cortex and subcortical white matter of the left frontal and temporal gyri ( Figure 1D ).