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Most easily seen on FLAIR are multiple regions of high T2 signal with positive mass effect. These involve the mesial temporal lobe on the right, extending up into the splenium of the corpus callosum and medial occipital lobe as well as involving the posterior thalamus. Additional high T2 signal and thickening of the cortex is noted in the posterior aspect of the insular
cortex. On the left region of similar change involves the parietal lobe, and middle and inferior temporal gyrus. On postcontrast imaging there is possible subtle wispy enhancement in the region of the splenium corpus callosum.
MR spectroscopy is largely unremarkable. MR perfusion suggests minor elevation of cerebral blood volume (CBV) in the region of the right side of the splenium of the corpus callosum.
Scattered through the white matter are patchy regions of high T2 signal, non -specific but suggestive of chronic small vessel ischaemic change. Remainder of the brain is unremarkable in appearance.
Multiple regions of high T2 signal with mass effect scattered across more than 3 lobes does not appear convincingly different from the previous MRI, although only 6 weeks have elapsed making all but rapid growth difficult to identify. Correlation with older studies is recommended.
Appearances favours gliomatosis cerebri, especially in light of marginal elevation of the cerebral blood volume (CBV) and possible wispy enhancement.