Fig. 2

Diagnosis and treatment with standard therapy of case 1, which included significant radiation to brainstem. a MR axial T2 FLAIR image of primary medulloblastoma diagnosed at age 8. b Radiation dose distribution showing craniospinal irradiation prescribed to 23.4 Gy and posterior fossa boost prescribed to 32.4 Gy. The brainstem is contoured in purple and received a mean dose of 50.1 Gy. c MR axial T2 FLAIR image of DIPG diagnosed at age 21, 13 years after treatment for primary medulloblastoma and in the area of the previously irradiated field. d MR spectroscopy with an elevated Chol/Cr ratio (1.66) that is consistent with malignancy (DIPG)