Case 5

This is an MRI brain study; the salient abnormality is an intra-axial space occupying lesion, which is centred on the midline in the splenium and body of the corpus callosum, appearing  symmetrical and extending into the peri-ventricular and deep white matter of the parietal lobes bilaterally (with some extension into the right frontal lobe). The mass shows heterogeneously high T2 and FLAIR signal intensity and low T1 SI, with surrounding significant FLAIR hyperintensity indicating vasogenic oedema. It is exerting mass effect on the adjacent lateral ventricles. It shows avid heterogeneous enhancement on the post contrast images, demonstrating irregular peripheral ring enhancement.

There is mildly restricted diffusion, showing somewhat low ADC values. 

This lesion most likely represents a butterfly glioma. The differential diagnosis is CNS lymphoma- however that is usually more homogeneously enhancing and would show much greater diffusion restriction.

I would notify the referring physician of the diagnosis and flag the case for discussion at neuro-oncology MDT.