Legend Axial images demonstrating T2 hyperintense infiltrating mass with involvement of both white matter and gray matter, with enlargement of involved structures. This mass involves the right frontal and temporal lobes with extension to the insular cortex.

Legend Coronal T2WI confirms involvement of the same areas. DWI image does not demonstrate restricted diffusion. Post contrast image shows no enhancement. Initial MR spectroscopy demonstrates normal brain metabolites with a normal Hunter’s angle.

Legend Followup images reveal extension superiorly in the frontal lobe with focal enhancement. Long and short echo MRS spectra demonstrate elevated choline, elevated myo-inositol and decreased NAA, consistent with dedifferentiation in an untreated lesion with change in biological activity. Key words: mri tumor neoplasia dwi mrs

Brain Diagnosis: Gliomatosis cerebri