There is a large intra-axial mass in the right insula extending anteriorly into the frontal operculum and inferiorly into the temporal lobe close to the amygdala. A small component extends inferolaterally to involve the right lateral orbital gyrus. This is joined to the main bulk of tumour by a small area of abnormal FLAIR hyperintense cortex via the inferior frontal gyrus.
There is extensive involvement of grey matter with gyral expansion in the insula and frontal lobe. The tumour is well circumscribed, brightly T2 and FLAIR hyperintense with a few small foci of FLAIR suppression.
There is very subtle wispy contrast enhancement in the mass.
No abnormal elevation of relative cerebral blood volume (CBV). MR spectroscopy is non-contributory.
No abnormal susceptibility related signal loss. No abnormal diffusion restriction.
Tumour exerts mass effect on the superior temporal gyrus and causes partial effacement of the right sylvian fissure and 2.5 cm of midline shift to the left.
Conclusion: Large intra-axial tumour centred in right insula. Appearance most in keeping with of low-grade glioma. Foci of FLAIR suppression, wispy contrast enhancement, and cortical involvement suggest protoplasmic or oligodendroglial components.