History of a left insular lesion. Preop planning for resection. History of prostate cancer. Limited sequences were obtained for stereotactic localization purposes. Within the left insular region adjacent to the left temporal pole is a heterogeneously intra-axial enhancing mass measuring 2.1 x 1.7 cm (series 501, image 92), provided previous precontrast imaging on the outside exam. There is also evidence of infiltrative gyral thickening and expansion of the insula with mass effect on the left basal ganglia and likely involvement of the left hippocampus. There is also nonspecific gyriform thickening in the left temporal lobe anteriorly and medially including the hippocampus, as well as abnormal T2 hyperintense signal extending along the left anterior commissure. Associated localized sulcal effacement is noted. The left temporal horn is partially effaced due to the mass effect and there is subtle flattening of the left cerebral peduncle. Branches of the left MCA course through and around the lesion without narrowing.Incidental note is made of a small cystic area within the clivus which likely represents a benign developmental finding such as a craniopharyngeal canal. Fiducials are noted along the skin surface.
Heterogeneously enhancing left insular mass with extension of abnormal signal involving the left insula, anterior and mesial left temporal lobe with gyriform thickening, and anterior left commissure. Localized mass effect noted with left MCA branches coursing around and through this area of abnormality. This is suspicious for a primary brain neoplasm.