What is the most favoured diagnosis for this brain tumour?
Glioblastoma (GBM). The imaging features are strongly suggestive of a high grade glioma tumour: a large tumour with irregular-enhancing margins, a central necrotic core and surrounded by vasogenic-type oedema. High vascularity on CBV and restrict diffusion foci also corroborate to this diagnosis.
What is the standard protocol for GBM's treatment?
Surgical resection + Stupp protocol (temozolomide + radiotherapy).
Within the left temporal lobe anteriorly there is a mass which is predominantly isointense on T1/T2 weighted sequences and demonstrates irregular enhancement on post-contrast imaging.
On these susceptibility weighted images, there are foci of low signal demonstrated inferiorly within the lesion. Foci of high signal intensity on the diffusion weighted imaging consistent with high cellularity.
The mass demonstrates vasogenic/tumoral oedema extending to the temporal lobe including the posterior limb of the internal capsule. There is approximately 9 mm of midline shift towards the right.
No hydrocephalus. Right cerebral hemispheric sulcal effacement.
MRS within the central aspect of the mass demonstrates the presence of lactate and the absence of other metabolites.
CBV at the margin of the lesion demonstrates increased vascularity.
Also seen within the posterior fossa is an extra-axial mass which demonstrates T2 hyperintensity and FLAIR suppression measuring 3.8 cm overlying the superior aspect of the left cerebellum consistent an arachnoid cyst