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  Indian J Med Microbiol
 

Figure 4: Patient 7 is a 54-year-old male, presented with progressive bilateral diminution of vision and right hemiparesis for 2 months, MRI showed (a) T2-hypointense lesion in the left occipital region, with perilesional edema. (b) Axial postcontrast T1-weighted image showed homogeneous enhancement. MR spectroscopy and perfusion were noncontributory. Differentials were high-grade glioma, PCNSL with rare possibility of metastases. FET-PET was done (c), which showed low-grade uptake in the lesion with a tumor-to-contralateral white mater (T/Wm) ratio of 1.6 at 5 and 20 min. Patient was not willing for biopsy; hence, whole-body FDG PET was done which showed rim of increased uptake in the brain lesion ([d] equal to gray matter), and primary site in the anal canal, seen on maximum intensity projection (MIP) image ([e] – arrow), biopsy showed anal melanoma, thus brain lesion was most likely metastatic. FET-PET (T/Wm) ratio was useful in ruling out high-grade glioma

Figure 4: Patient 7 is a 54-year-old male, presented with progressive bilateral diminution of vision and right hemiparesis for 2 months, MRI showed (a) T2-hypointense lesion in the left occipital region, with perilesional edema. (b) Axial postcontrast T1-weighted image showed homogeneous enhancement. MR spectroscopy and perfusion were noncontributory. Differentials were high-grade glioma, PCNSL with rare possibility of metastases. FET-PET was done (c), which showed low-grade uptake in the lesion with a tumor-to-contralateral white mater (T/Wm) ratio of 1.6 at 5 and 20 min. Patient was not willing for biopsy; hence, whole-body FDG PET was done which showed rim of increased uptake in the brain lesion ([d] equal to gray matter), and primary site in the anal canal, seen on maximum intensity projection (MIP) image ([e] – arrow), biopsy showed anal melanoma, thus brain lesion was most likely metastatic. FET-PET (T/Wm) ratio was useful in ruling out high-grade glioma