A 67-year-old man was admitted to our hospital with a history of weakened left limbs and muscle twitching. On physical examination the muscle strength of the left upper limb was grade 2 and grade 4 on the lower limb. T2-weighted MRI revealed the lesion involving the right centrum ovale and part of the precentral gyrus. The FA value of the affected white matter was slightly lower (0.28) compared with the contralateral side (0.40). DTI-based fiber-tracking displayed a right CST passing through the lesion without interruption (fig. ). The patient refused surgery, therefore no histopathological diagnosis was made. However, an increased choline concentration (maximum choline/creatine and choline/N-acetylaspartate ratios of 3.04 and 4.51, respectively) was detected in the lesion with MRS study, which was highly suggestive of tumor.
A 67-year-old man was admitted to our hospital with headache and weakened left limbs. Muscle strength on the left side was grade 4. Routine MRI displayed a mass lesion close to the posterior horn of the right lateral ventricle with low T1-signal intensity and high T2-signal intensity. Peritumoral edema was markedly presented and showed lower FA (0.08-0.22) compared to the contralateral whiter matter (0.40). Fibers displayed interruption distally to the right CST (fig. ) and did not significantly improve using an FA cut-off value of 0.10 for fiber-tracking. The mass was confirmed to be a metastatic tumor from a renal cell carcinoma of the right kidney after histopathological findings.