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A large heterogeneous enhancing mass centred on the left basal ganglia is demonstrated which measures approximately 5 cm in diameter. It extends to involve the temporal lobe, insular cortex, posterior aspect of gyrus rectus, and extends across the midline via the anterior commissure into the right internal capsule. It is surrounded by a mantle of high T2 signal, and exert significant positive mass effect with 8 mm of midline shift. No hydrocephalus. Centrally within this lesion and areas of non-enhancement, with petechial regions of signal loss on EPI is probably representing blood product. No restricted diffusion.
A 2nd focus of high T2 signal with enhancement is seen in the right frontal lobe involving the inferior frontal gyrus. This area is not continuous with the 1st, with no bridging high T2 signal between the two regions.
A 3rd region also with high T2 signal and subtle enhancement involves the left side of the medulla and inferior cerebellar peduncle and floor of the 4th ventricle just lateral to the facial colliculus.
Multifocal intracranial enhancing masses has a differential of multifocal high-grade glioma or multifocal CNS lymphoma. Heterogeneous enhancement, and (to a lesser degree) absence of restricted diffusion favour the former whereas the distribution and character of enhancement is more suggestive of lymphoma.