Multifocal bilateral centrum semiovale (frontal and parietal) and deep periventricular white matter enhancing bright FLAIR abnormalities. Larger lesions line left lateral ventricle body (36x16mm axial) and trigone (17x14mm axial). The anterior lesion has subependymal spread along floor of left lateral ventricle to involve the fornix body at midline, and shows diffusion restriction along its deep aspect and patchy mild increased blood volume. Small area of patchy enhancement also seen along left temporal horn. The 2 larger enhancing lesions are T2 and FLAIR hypointense, and their superolateral borders have a linear streaky enhancing pattern along a vascular alignment. The left frontal enhancing lesion is also linear.
Bright FLAIR signal are marked around the enhancing lesions, extending into left parietal lobe, striatocapsular region, and thalamus to its pial surface with the 3rd ventricle. No susceptibility artefact associated with these lesions.
There is slight left lateral ventricle effacement. Minimal midline shift at level of foramen of Munro. No hydrocephalus.
Markedly increased Lac/lipid, slightly increased Cho and reduced NAA in some areas but not all. This is nonspecific trace, but would represent neoplasm in setting of other MRI findings.
Comment
Findings most favour cerebral lymphoma.