Female, 68 years old, with word finding difficulties. Brain lesion. Evaluate for growth, change. A large region of parenchymal thickening and T2 hyperintensity is seen centered on the left temporal lobe with involvement of both cortex and white matter. The lesion fills a majority of the left temporal lobe but does not extend completely to the anterior temporal tip. Posteriorly and superiorly, the lesion extends in infiltrative fashion into the left occipital lobe, the left splenium of the corpus callosum, and then superiorly into the left parietal white matter. In maximal dimension, the lesion measures up to 88 mm.The region of the lesion demonstrates mild diffusion restriction suggesting hypercellularity. The lesion enhances in a very vague and cloudlike matter with a few superimposed small nodules of enhancement. Increased vascularity within the lesion can be appreciated visually on the postcontrast images and is corroborated by rCBV mapping which shows significant elevated blood volume. Single and multi voxel spectroscopy performed on the lesion shows significant elevation of choline, reduction of NAA and presence of above normal levels of lipid. Myoinositol, an astrocytic marker, is also elevated within the lesion.The lesion induces moderate regional mass effect in the form of sulcal effacement and effacement of the left ventricular atrium and temporal horn. No brain herniation is suspected. Elsewhere in the brain, scattered small foci of T2 hyperintensity are seen in the periventricular regions, a nonspecific finding which may reflect chronic microvascular ischemic disease. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is seen. The ventricular system, except as above, is unremarkable.
A large infiltrative masslike lesion is seen centered on the left temporal lobe with extension into the occipital and parietal lobes as well as the splenium of the corpus callosum. Data from blood volume mapping and spectroscopy favor a glioma, perhaps of relatively higher grade.