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Technique: Multiplanar, multisequence imaging including pre and post contrast, perfusion and spectroscopy. No previous imaging available for comparison. Stereotaxis also performed for surgical planning.
Findings: There is a peripherally enhancing mass in the left parietal lobe corona radiata extending to the ventricle. There is irregular peripheral enhancement with central necrosis and increased cerebral blood volume and evidence of haemorrhage into the lesion. There are patchy areas of low ADC in the lesion and spectroscopy shows relatively increased choline and lactate and reduced NAA in keeping with a glioma trace (Spectroscopy not shown above). Non enhancing tumour extends into the splenium of the corpus callosum and left cuneus as well as into the fornices that are thickened. There is mild mass effect on the left lateral ventricle without midline shift.
Superior frontal gyrus high T2 signal is suggestive of further disease, although gliosis is also a possibility (low CBV).
Conclusion: Findings are those of a high grade glioma (WHO IV) with extensive extension across the midline and with a possible second non-enhancing focus in the frontal lobe (gliomatosis).