A heterogenous right temporal lobe mass with thick irregular enhancing margins and central non-enhancement is noted. Surrounding high flair/T2 signal consistent with vasogenic oedema. Susceptibility artefact centrally is consistent with blood product. Compression of the right midbrain and right lateral ventricle with entrapment and dilatation of the left lateral ventricle. 3mm midline shift to the left and effacement of the overlying sulci. The right MCA is displaced anteriorly.
MR perfusion demonstrates elevation of cerebral blood volume. MR spectroscopy demonstrates reduced NAA and elevated lactate. Choline is elevated in the peri-tumoural white matter.
Conclusion:
- Findings are consistent with a high grade glioma (GBM) in the right temporal lobe
- Incidental pineal lesion has a solid enhancing component, larger than normal pineal tissue and thus is suspicious for a pineal tumour, most likely a pineocytoma.