Case 68. Case 68. Unspecific benign pseudotumoral mass. A, FLAIR-weighted images show enlargement and hyperintensity of the head of the right caudate nucleus.

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Presentation transcript:

Case 68. Case 68. Unspecific benign pseudotumoral mass. A, FLAIR-weighted images show enlargement and hyperintensity of the head of the right caudate nucleus and left thalamus. B, T1-weighted images after contrast administration show slight discontinuous contrast enhancement. C, 1H-MR spectroscopy at short TE. Ratios between CHO, Cr, and NAA are within the normal range. D, 1H-MR spectroscopy at long TE shows no significant anomalies in the ratios between CHO, Cr, and NAA. E, Graph constructed with the mIns/NAA ratio at short TE (x axis) and CHO/NAA ratio at long TE (y axis) of the universe (latent space) of cases of the training-set projects the case (cross) in the nontumoral area. The straight line in the graph depicts the cutting point between tumor and pseudotumor on the basis of the combined ratio value (formula, x + y = 3.33). The arrow highlights the position of the case. Values obtained for the classifiers were mIns/NAA ratio at short TE, 0.48 (<0.90, suggesting nontumor); CHO/NAA ratio at long TE, 0.55 (<1.90, suggesting nontumor); and combined ratio, 1.03 (<3.3, suggesting nontumor). The pathologic assessment of a stereotactic biopsy was “inflammatory changes.” F, Follow-up with axial FLAIR images obtained in 8 months shows complete resolution of previous abnormalities in the images. Note a small hypointense area on the head of the caudate nucleus (arrow) corresponding to the biopsy area. C. Majós et al. AJNR Am J Neuroradiol 2009;30:544-551 ©2009 by American Society of Neuroradiology