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Technique: Multiplanar, multisequence imaging has been obtained through the brain including pre and post contrast sequences, MR perfusion and MR spectroscopy. No previous imaging for comparison.
Findings: Centred on the left frontal lobe is a peripherally enhancing lesion with dimensions of 5.9cm x 4.4cm x 4.2cm (AP x trans x CC). The central component of this mass demonstrates hyperintense T2 signal suggestive of necrosis. Abnormal FLAIR hyperintense signal extends to the left basal ganglia and deep white matter, across and expanding the genu and anterior body of the corpus callosum, and into the right frontal lobe. Mass effect results in subfalcine herniation to the right, significantly distorts the lateral ventricles and effaces the left frontal cerebral sulci.
Patchy foci of predominantly peripheral diffusion restriction correlate with low ADC values and represent highly cellular regions of tumour.
MRS demonstrates reversal of choline:creatine ratio, elevated lipid/lactate peak and decreased NAA.
Increased cerebral blood volume (CBV) within the enhancing component of the tumour.
Other smaller foci of white matter FLAIR hyperintense signal throughout the cerebral white matter, without enhancement, are likely to represent chronic small vessel ischaemia, within normal limits for age.
Conclusion: Findings are those of a left frontal high-grade glioma (WHO IV, GBM).