The typical cortical and subcortical PRES lesions showed reversibility, whereas the brain stem and deep white matter lesions showed less reversibility. PRES due to eclampsia showed maximum reversibility compared to hypertension- and drug-related PRES. DWI, even with ADC maps, had limitations in predicting the course of PRES.
A cone-beam lowers the X-ray exposure level and the contrast material dose used compared to those for the conventional angiography-computed tomography (angio-CT) technique. Herein we present a patient with a metastatic skull base bone tumor in which the subtraction image of cone-beam CT with a flat panel detector was useful for evaluating the vascular supply during superselective intraarterial chemotherapy. Although the image quality of cone-beam CT is poorer than that of conventional angio-CT, the cone-beam CT system is sufficient for clinical use.
Disseminated necrotizing leukoencephalopathy (DNL) is a potentially fatal complication of treatment involving intrathecal administration of chemotherapeutic agents such as methotrexate (MTX) alone or in combination with cranial radiotherapy (RT). We describe a case of acute lymphoblastic leukemia (ALL) treated with high-dose intravenous and intrathecal methotrexate combined with craniospinal RT resulting in DNL. Typical MR imaging features of progressive deep white matter lesions showing a characteristic pattern of enhancement after contrast was seen in this case. Deep white matter lesions with ring-like enhancement and calcifications were seen on CT; it showed a mass effect at one stage, which is not typical for DNL. Long-term clinical and imaging follow-up were helpful for the diagnosis in this case.
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