Bilateral few (three in number) subcortical cystic SOLs are seen at the left frontal and bilateral parietal regions, the largest is seen at the left parietal lobe measuring about 3 x 2.6 cm along its maximal axial diameters. It elicits a low signal in T1 WI, a high signal in T2 and FLAIR Wis with central cystic signal and peripheral soft tissue enhanced component with peripheral restricted signal and central facilitation in DWIs.
Surrounding subcortical vasogenic edema is seen together exerting a secondary mass effect in the form of effacement of cortical sulci and attenuation of the frontal horns of the lateral ventricles more on the right side.
MR spectroscopy showed:
- elevated choline peaks with increased choline:creatine ratio
- depression of the neuronal markers (N-acetylaspartate (NAA) peak)
- elevation of the lipid/lactate peak
- no myoinositol peak elevation