Presentation
Headache.
Patient Data
Left temporal large subcortical well-defined space-occupying lesion. It measures 4.2x3.5 x3.5 cm along its max TS,AP and CC dimensions. It elicits low signal on T1 WI and high signal on T2 with central necrosis. It shows marginal diffusion restriction and heterogenous post-contrast enhancement. The lesion is surrounded by marked vasogenic edema signal and is exerting a positive mass effect.
MRS shows elevated Choline peak and Cho/Cr peak, reduced NAA and elevate lipid, lactate peak.
Conclusion: The morphological and MRS criteria are suggestive of a neoplastic process, likely metastatic rather than high-grade glioma.
Case Discussion
The patient had a history of treated breast cancer two years ago. With recent complaints of headaches.
Surgical excision of the lesion showed metastatic carcinoma.