Legend Axial FLAIR images show T2 hyperintensity involving the right occipital lobe, the mesial temporal lobe and the splenium of corpus callosum, crossing the midline to involve the left occipital white matter. Mass effect is demonstrated in the regions of signal abnormality. Isointense region just lateral to the the occipital mass is either a cyst or related to prior surgery.

Legend Left: Axial FLAIR again shows T2 hyperintensity in the occipital lobe, the splenium of corpus callosum, and crossing the midline. Abnormal T2 hyperintensity is also noted in the right basal ganglia. Right: Axial post contrast T1WI image shows mild heterogeneous enhancement within the occipital lobe. The right atrium is displaced anteriorly and enhancement of the displaced choroid plexus is seen.

Legend Single voxel, long TE MRS over the enhancing zone shows decreased NAA and significantly increased Choline peak.

Legend Multi-voxel MRS over the enhancing zone shows abnormal spectra over most of the voxels with normal spectrum in the lower right corner in the medial left occipital lobe. Key words: mri tumor neoplasia glioma mrs

Brain Diagnosis: Anaplastic astrocytoma (Grade 3)