MRI
Axial FLAIR
Axial T2
Axial T1
Axial T1 C+ fat sat
Axial DWI
Axial ADC
Axial SWI
Axial MR Perfusion (CBV)
MRS
Axial T1 C+ CBV fusion
Large expansile FLAIR hyperintense minimally centrally enhancing tumour in the medial aspect of the right frontal lobe centred in the anterior of the cingulate gyrus, involving the genu of the corpus callosum and extending across the midline to involve the medial aspect of the left frontal lobe. The tumour also extends more anteriorly and inferiorly in the frontal lobe to involve the straight gyrus and also inferolaterally along the base of the brain. There are regions of elevated CBV within the tumour. Spectroscopy demonstrates increased choline with reduced NAA but no large lactate peak.
Multiple regions of susceptibility artefact and hypointense on phase imaging within the tumour likely represent calcifications. Midline shift anteriorly measures up to 10 mm displacement of the anterior cerebral arteries to the left
Conclusion:
Large right frontal tumour with subtle central enhancement compatible with infiltrative glioma. Elevated CBV within the tumour may be due to oligodendroglial histology of the tumour rather than indicating a higher grade.