Contrast not administered due to developing acute renal impairment.
A right temporal intra-axial multiloculated cystic appearing mass with the nodular and linear bands of tissue, shown to enhance on CT, are present. The surrounding FLAIR hyperintensity extends to the cortex. Local mass-effect with right hemispheric sulci effacement, displacement and compression of the right lateral ventricle, and midline shift. Uncal herniation distorts the right midbrain. Part of the nodule demonstrates susceptibility and high CBF on ASL. The wall is also partially lined by susceptibility. No fluid-fluid level. Spectroscopy demonstrates only the occasional voxel with elevated choline. No other lesion is identified apart from several small scattered foci of FLAIR hyperintense in the supratentorial white matter.
Conclusion: Unusual appearing lesion. In this age group an atypical appearing GBM or an unusually large solitary metastasis are statistically most common, however, would usually have different appearances. Alternative diagnoses that more commonly would have this appearance, but more commonly occur in a younger age group, include a PXA, ganglioglioma or supratentorial ependymoma.