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Within the left superior temporal gyrus there is a 2.5 x 2.6 x 2.3 cm rim enhancing lesion - localising to grey-white interface rather than cortex. The lesion is heterogeneous on T1 and T2 weighted sequences with moderate diffusion restriction identified throughout. On susceptibility imaging, a complete hypointense rim is not identified. There is increased rCBV within the enhancing portion of the lesion.
Spectroscopy demonstrates elevated lactate peak and markedly depressed NAA within the non-enhancing central portion of the lesion. At the periphery of the lesion, there is moderate NAA reduction, but choline peak assessment is limited by a wandering baseline.
There is extensive surrounding white matter T2 hyperintensity in keeping with vasogenic oedema. There is resultant mass-effect with effacement of the left temporoparietal sulci and minor effacement of the left lateral ventricle. No hydrocephalus or midline shift. The basal cisterns are preserved.
No other lesion identified.
Peripherally enhancing mass within the left superior temporal gyrus with surrounding vasogenic oedema. The main differential is between metastasis and GBM.
Although there is diffusion restriction of the lesion, this is not isolated to the central non-enhancing component, and the thick irregular rind favours tumour over abscess.