Direct correlation is made with the CT scan performed above. In the right frontal lobe, there is a large area of abnormal signal intensity with two areas of enhancement. The superior lesion near the vertex measures 2 cm x 2 cm.. It is intra-axial and situated in the superior frontal gyrus. It is iso-intense to grey matter on T1, has heterogeneous intensity on T2 weighted images and demonstrates peripheral enhancement. Hypointensity within the lesion on the EPI is consistent with blood products. The second area of enhancement measures 2 cm x 2.3 cm and is situated adjacent to the falx has a subfalcine extension to the left. It is likely to be intra-axial rather than a separate extra-axial lesion. It is hypointense on T1 and isointense to grey matter on T2 and demonstrates patchy enhancement. There is significant vasogenic oedema. There is at least 1 cm of midline shift with subfalcine herniation and effacement of the frontal horns of both lateral ventricles. In the right basal ganglia, a small lesion of hyperintense T2 signal is seen. This is consistent with an old lacunar infarct. There are several other small foci in the white matter which are non-specific. No other intraparenchymal abnormality is seen. No other abnormal enhancement. Ventricular size is normal.
Conclusion: Large right frontal lesion described is likely to be one lesion with two areas of enhancement. The most likely diagnosis is a glioma (glioblastoma multiforme) with multifocal enhancement. The inferior abnormality has an unusual appearance that is abutting the falx, there is a possibility that the patient has two pathology with the superior one being a glioma and the inferior on being a meningioma. However, this is thought to be unlikely.