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There is confluent T2 / FLAIR hyperintense signal abnormality affecting the corona radiata and the centrum semiovale of the cerebral hemispheres with involvement of the corpus callosum, the right frontal operculum, the hippocampi, to lesser extent the thalami and the left cerebral peduncle. In the right frontal operculum there is involvement of grey and white matter, and the suggestion of gyral expansion.
Within the centrum semiovale, there are number of focal high T2 / FLAIR hyperintensities with predominantly peripheral irregular enhancement. The largest on the right measures 0.7 x 1.4 x 2.0 cm.
The largest on the left measures 1.1 x 1.5 x 2.1 cm.
In addition there is a 5 mm nodule of enhancement within the body of the corpus callosum and a 6 mm rather enhancing nodule in the chest cortical white matter of the right middle frontal gyrus.
There is diffusion restriction within the T2 hyperintense signal abnormality in the centrum semiovale bilaterally. There is no leptomeningeal enhancement. There is no pathological susceptibility artefact.
Conclusion: There are bilateral confluent T2 hyperintense abnormalities in the cerebral hemisphere with predominantly peripheral irregular areas of contrast enhancement as detailed. Appearance could represent gliomatosis with foci of higher-grade glioma.
Tumefactive demyelination (monophasic acute disseminated encephalomyelitis) and atypical infection (particularly if the patient is immunocompromised) should also be considered.
Comparison with previous imaging and CSF analysis would be very useful.