The large and bilobed extra-axial mass is again demonstrated extending into destroying left parietal bone and with an intra dural component that severely indents the left frontoparietal lobe. At the deep margin where brain parenchyma is indented, there are 2 cystic components. There is marked left frontoparietal vasogenic oedema which extends inferiorly along internal and external capsules. The lesion has heterogeneous low and intermediate T2 signal and demonstrates a diffuse vivid enhancement. No internal diffusion restriction. A few foci of susceptibility artefact reflect calcification or blood product. There is linear dural enhancement extending along the displaced and distorted dura. There is 12 mm of midline shift toward the right at the level of the foramen of Monro and uncal herniation with the distorted region of the midbrain. No tonsillar herniation. Dilated entrapped left temporal horn. No distant areas of pathological enhancement. A few small T2 hyperintense white matter foci are compatible with expected age-related changes of chronic small vessel ischaemia.
Conclusion: Severe mass effect due to a large left extra-axial mass with intraosseous and intradural components. The main differential diagnosis is between metastasis, meningioma, and haemangiopericytoma.