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A large region of high T2 signal with positive mass effect involves a majority of the left frontal lobe, with expansion also of the caudate nucleus and lentiform nucleus and signal creeping into the corpus callosum. Superiorly within this region is a 3.0 x 4.0 cm vividly enhancing component, with central areas of non-enhancing suggestive of necrosis. Spectroscopic trace of this lesion demonstrates marked elevation of choline, depressed NAA, and a large lactate peak. Perfusion demonstrates markedly elevated cerebral blood volume (CBV).
In the right frontal pole in further region of high T2 signal is demonstrated involving the anterior aspect of the superior frontal gyrus, embedded within it are two enhancing nodules measuring 5mm and 9 mm in diameter. It is difficult to demonstrate convincing bridging high T2 signal across the corpus callosum between the two frontal lobes.
Involving the posterior aspect of the middle temporal gyrus on the left is a further region of high T2 signal with thickening of the cortex, without abnormal enhancement.
The remainder of the brain is unremarkable in appearance.
Presence of abnormal signal with mass effect involving three lobes, with enhancing masses in the frontal lobes as described suggests gliomatosis cerebri, with high-grade (WHO grade VI - GBM) component within the left frontal lobe and smaller also high grade component in the right frontal lobe. There is likely un-seen bridging white matter disease consistent with multifocal glioblastoma (rather than multicentric glioma).