MRI Brain (glioma protocol)
Technique: Multiplanar, multisequence imaging has been obtained through the brain including pre and post contrast sequences, MR perfusion and MR spectroscopy. Comparison made with the previous CT and MRI studies from the previous weeks.
Findings: Within the left posteromedial temporal lobe a lesion with dimensions of 16 mm x 15 mm x 14 mm ( CC x trans x AP ) demonstrates irregular nodular enhancement. The lesion has intrinsic low T1/high T2 signal. There is minimal surrounding FLAIR abnormal signal. This is probably contiguous with an abnormality within the posterior aspect of the left middle temporal gyrus that has cortical FLAIR hyperintense signal and gyral expansion, associated sulcal effacement and local nodular sulcal enhancement.
No susceptibility artefact to suggest recent or previous haemorrhage or calcification. DWI signal within the white matter lesion is hyperintense without low ADC value.
Perfusion studies demonstrate elevated cerebral blood volume. Spectroscopy (not shown) reveals reversal of choline: creatine ratio with a slight decrease in NAA. Elevated choline extends beyond the FLAIR/enhancing abnormality. No elevated myoinositol. No definite bony remodelling.
Conclusion: Overall the findings within the left temporal lobe are most in keeping with tumour. Although slightly unusual, a glial series tumour, particularly a higher grade astrocytoma or oligodendroglioma with the elevated CBV, with local leptomeningeal involvement, is thought most likely.