There is a lobulated, vividly enhancing mass within the right temporal lobe. The mass demonstrates heterogeneous T1 and T2 signal and multiple round/ovoid foci of internal non-enhancement, these foci demonstrating central elevated signal on diffusion-weighted imaging with ADC depression. More superiorly, an ovoid low T1, high T2 focus measuring 32 x 18 mm demonstrates no DWI signal elevation.
There is very extensive right frontotemporoparietal T2/FLAIR hyperintensity in keeping with surrounding vasogenic oedema, infiltrating the basal ganglia, effacing right cerebral sulci, narrowing the right lateral ventricle and resulting in marked contralateral (left) lateral ventricular distension (trapped ventricle). There is uncal herniation on the right, moderate leftward subfalcine herniation and leftward midline shift. Some periventricular T2/FLAIR hyperintensity likely reflects some transependymal oedema.
The inferior aspect of the mass abuts the right Sylvian fissure, abutting and narrowing the right middle cerebral artery as well as displacing it anteriorly with probable encasement of several branches. The dura adjacent to the mass at the temporal pole appears thickened and enhances. No extra-axial collection is seen.
There is elevated CBV in the enhancing portion of the mass. MRS is non-contributory (not shown). Gradient sequences demonstrate no focal intracerebral haemorrhage.
No other abnormal focus of contrast enhancement is identified.
Large right temporal lobe mass with vivid enhancement. Internal foci of non-enhancement with central DWI signal elevation/ADC depression in a component raises the possibility for a multiloculated cerebral abscess (especially from an atypical organism, e.g. TB) although the restricting component could represent protein-rich necrotic fluid in a high-grade glioma.