 As seen on the outside exam, there is a large infiltrative appearing process with a thick rindof irregular heterogeneous enhancement centered in the right parietal lobe. There are numerous associated flow-voids, and the mass extends to the posterior right lateral ventricular margin. On T2-weighted images, there is central hyperintense signal, with a rind of mildly increased T2 signal, greater in signal than normal cortex. Abnormal enhancement and signal also extends in an ill-defined manner along the splenium of the corpus callosum on the right side, which is also expanded. The mass was noted to demonstrate mild hyperattenuation along the areas of MR enhancement as well as associated diffusion restriction in these areas on outside MRI consistent with hypercellularity. Susceptibility is also noted on the outside exam, most prominent in the area of focal nodular enhancement along the posterior aspect of the right lateral ventricular body. There is relatively only mild to moderate localized mass effect.In addition, there is abnormal confluent T2 hyperintensity focally within the left superior temporal lobe, without significant mass effect. Multiple oval and punctate areas of T2 hyperintensity are again seen throughout the cerebral white matter, most focal in the frontal lobes and along the corona radiata. There are some lateral left basal ganglia chronic lacunar infarcts suggested. Multiple chronic appearing lacunar infarct are also present within the brainstem, with diminutive appearance especially of the left cerebral peduncle, with evidence of previous hemosiderin deposition along the midbrain previously. There are likely a few small chronic lacunar infarcts in the cerebellum bilaterally. The ventricles and sulci are prominent, consistent with mild to moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which may represent a background of mild to moderate chronic small vessel ischemic changes. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are grossly within normal limits. There is patchy opacification of the right posterior ethmoid air cells.
1.Redemonstration of infiltrative appearing process centered in the right parietal lobe white matter with mild to moderate localized mass effect. Associated punctate flow-voids seen throughout the areas of more solid appearing tissue, which demonstrates a lacelike pattern of enhancement, predominantly relating with the prominent vessels. Differential diagnosis includes an inflammatory abnormality, including a demyelinating process which may be fulminating and hemorrhagic, based on prior outside MRI appearance, versus infiltrative primary brain neoplasm versus less likely angiocentric lymphoma.2.Additional areas of abnormal signal throughout the white matter, most focally in the superior left temporal lobe as well as in the frontal periventricular white matter and corona radiata. Other extensive supratentorial and infratentorial white matter changes which appear to correlate with multiple chronic lacunar infarcts with even left Wallerian degeneration, much greater than expected for the patient's stated age with regard to chronic small vessel ischemic changes, although other etiologies for the white matter findings as related to the above process is not excluded.