MRI better delineates the extent of the disease. We see a marked mass-like T2/FLAIR signal abnormality centred in the right parieto-occipital white matter. Signal abnormality extends across the splenium of the corpus callosum and into the posterior right mesial temporal lobe. Mass effect is similar to the same-day head CT, with regional cortical and lateral ventricular effacement.
On diffusion, we see mostly T2-shine through effects, as evidenced by hyperintensity on ADC maps.
Following contrast administration, we see marked heterogeneous enhancement, particularly along the periphery of the lesion. The post-contrast MP RAGE better characterises the speckled and linear perivascular enhancement of the lesion than the post-contrast with fat suppression. SWI shows subtle punctate and fine linear hypointensity corresponding to the areas of enhancement, suggesting of microhaemorrhage.