Figure legends:
Figure 1. T2-weighted MRI, Axial sections, sequences at the level of the
pons.
- Diagnostic MRI shows high T2 signal and enlargement of the pons
encasing the basilar artery and left lateral extension towards the
cerebellar peduncle and left cerebellar hemisphere consistent with
DIPG.
- 3 month-follow up MRI after surgical biopsy and radiation therapy
shows significant reduction of the pontine tumefaction and cerebellar
peduncle extension compatible with partial response.
- 15 months after first irradiation, there is new enlargement of the
pons with high signal consistent with progressive disease.
- MRI after reirradiation. There is a new radiological improvement with
reduction of the pons size and less high T2 signal compatible with
partial response.17
Figure 2. Sagittal FLAIR + post-gadolinium at relapse (A) and after
re-irradiation (B).
Both the primary brainstem lesion and the metastasis (anterior recesses
of the III ventricle, in relation with the corpus callosum and mid-line
frontal lobes) show volume
reduction and improvement of signal abnormality.