Dilated perivascular spaces in the anterior temporal lobe are variants of tumefactive perivascular spaces and tend to involve the subcortical white matter.

The majority of these lesions are surrounded by perilesional changes in signal intensity. It is suggested that this finding represents gliosis secondary to mass effect with surrounding chronic ischemic changes. 

Generally, dilated perivascular spaces tend to prefer certain specific locations. This characteristic is helpful in ruling out other sinister lesions. Another important distinguishing feature of anterior temporal lobe dilated perivascular spaces is its close proximity to the adjacent middle cerebral artery.

The lack of enhancement and size stability over time are also considered supportive features of dilated perivascular spaces.