Glioblastoma - solitary ring enhancing lesion

FINDINGS: A space-occupying lesion with enhancing thick irregular walls and central necrotic core is seen in the left frontal lobe white matter. Marked surrounding vasogenic edema, effacement of the underlying ipsilateral lateral ventricle, and contralateral midline shift of 8 mm are noted. No other focal space-occupying lesion is seen.

CONCLUSION: Left frontal lobe ring-enhancing space-occupying lesion with mass effect, which is likely a primary brain tumor; other possible differential includes brain abscess & solitary brain metastasis.

FINDINGS: A solitary irregular heterogeneous mass lesion, measuring approximately 30 X 25 mm, is seen in the left frontal lobe. Its peripheral part is isointense on both T1 & T2-weighted images, shows mild restriction on diffusion-weighted images and thick irregular enhancement on post-contrast images. It has a central cystic/necrotic non-enhancing component.  Associated significant surrounding vasogenic edema and mass effect in the form of the effacement of the frontal horn of the left lateral ventricle as well as mild midline shift towards the right side is also noted.  The imaging differential diagnosis for this lesion remains the same (primary brain tumor, metastasis,  and less likely an abscess).

Residual ring-enhancing lesion and recent postoperative changes are seen in the left frontal lobe.

A few well-defined focal hyperechoic lesions are noted in the right hepatic lobe (segments VI, VII & VIII). No significant internal vascularity is seen in these lesions on the color Doppler ultrasound examination. These hepatic lesions are likely hemangiomas. However, in view of the history of cerebral lesion, the possibility of metastases (though less likely) cannot be excluded.

After the ultrasound examination, a contrast-enhanced CT abdomen was performed (not shown here) which was suboptimal in the characterization of these hepatic lesions due to technical issues and a radionuclide RBC scan was recommended for further evaluation.

Multiple focal areas of increased isotope concentration, (which increased with passage of time in 2 hours delayed images), are noted in the segment VI, VII and VIII of the liver. These lesions are consistent with hepatic hemangiomas.

An irregular focal lesion having peripheral enhancing walls and necrotic non-enhancing center is seen in the left frontal lobe. Lesion extension into the genu of corpus callosum, marked perilesional edema and mass effect over the ipsilateral lateral ventricle are noted; however, no midline shift is seen. In comparison with the previous brain imaging; the current MRI features are suggestive of progressive disease.