PMC8578854_01
Imaging findings at initial diagnosis and at 11 years of follow-up in a patient with a left frontal NSCLC (adenocarcinoma) brain metastasis treated by resection and whole brain radiotherapy. (A) The T1-weighted contrast enhanced MR (T1CE) and FET PET (PET) images revealed a contrast enhancing, PET-positive metastatic tumor with no evidence of recurrence in the brain or resection cavity during follow up. (B) The T2-FLAIR images at initial diagnosis. (C) At follow-up, extensive areas of T2-FLAIR hyperintensities developed in the white matter of the bilateral dorsal frontal and parietal lobes. All images are shown after elastic registration to the MNI-152 standard brain template.
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F1
At initial diagnosis, the brain metastasis presented with localized MR contrast enhancement, increased uptake of FET and a well circumscribed, local T2/FLAIR hyperintensity covering the tumor and a small rim of normal brain tissue (Figure 1).
Cognitive test scores for Trail Making Tests A and B (measured in seconds, lower numbers mean better results) and for the tests scored by the number of items achieved (higher scores mean better results). Significant performance differences between the WBRT patient and the healthy subjects were observed for cognitive domains with a component of executive functioning (TMT-A: attention/ processing speed, TMT-B: executive function/concept shifting, supermarket test: semantic word fluency), while the scores for the memory domains were not significantly lowered. For the healthy subjects, means +- standard deviations are depicted; *p < 0.05, **p < 0.01, one-sample t-test.
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F2
(A) Overlay of the patient's FLAIR images registered to the MNI-152 space with the color-coded cortical areas belonging to 7 resting-state networks. (B) Mean resting-state functional connectivity in 10 healthy subjects and in the patient depicted together with the scheme of resting-state networks. (C) Within-network and inter-network resting state connectivity (RSFC, mean z-normalized Pearson correlation coefficient of positive-valued connections) for each of the seven resting-state networks in the whole brain radiotherapy (WBRT) patient compared to the healthy subjects. For the healthy subjects, means +- standard deviations are depicted. *p < 0.05, **p < 0.01, ***p < 0.001, one-sample t-test. Vis, Visual Network; SM, Somato-Motor Network; dAtt, Dorsal Attention Network; vAtt, Ventral Attention Network; Limb, Limbic Network; FPC, Fronto-Parietal Control Network; DMN, Default Mode Network.
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F3
As depicted in Figures 3A,B, the mean RSFC matrix of the healthy subjects showed a clear pattern reflecting the structure of the underlying resting state networks. The analysis of the within-network RSFC (Figure 3C) revealed a significant reduced connectivity within all seven networks.