Confluent left frontoparietal white matter FLAIR signal abnormality with mass effect and multifocal enhancement within. The high T2 signal change spares the cortex with no evidence of non-enhancing tumour. The largest enhancing lesion measures, demonstrates central non-enhancing cystic components and extends to the corticomedullary junction. No intrinsic T1 hyperintensity. At least five further small foci of nodular enhancement are present through the area of signal abnormality.
Conclusion
The differential is between a multifocal glioblastoma and a cluster of cerebral metastases. If non-enhancing tumour were present, the diagnosis of a glioma could be made with confidence. Its absence, however, is not as helpful.