Figure 2

Indolent enhancing spinal lesion (IESL)—Case 2. An 11-year-old boy with medulloblastoma of the cerebellum (a,b) had undergone surgical resection and chemoradiotherapy. Sagittal contrast-enhanced T1WI revealed multiple enhancing foci in the cervical to thoracic spine 15 months after the diagnosis (c,d). Focal leptomeningeal seeding was noted at the C1 level (c, black arrow). In the follow-up MRI 33 months after brain tumor surgery, sagittal contrast-enhanced T1WI revealed significantly progressive changes in the lesion at vertebrae T11 with a target enhancement pattern (e, arrow). The lesion exhibited hypointensity on T1WI (f) and hypointensity on T2WI (g). Several enhancing lesions were also present at the temperoparietal skull bone of the brain MRI (h). On axial images, the T11 lesion had strong enhancement on contrast-enhanced MRI T1WI (i) and osteoblastic changes on the CT scan (j). CT-guided biopsy of the T11 lesion showed mild marrow fibrosis, adipose tissue filled in the marrow spaces, and scattered hematopoietic cells (H&E staining) (k,l).