Magnetic resonance perfusion and spectroscopy in a giant tuberculoma

Magnetic resonance imaging (MRI) of the brain revealed a lobulated T2-weighted hypointense mass lesion in the right cerebellar hemisphere with adjacent vasogenic edema causing mass effect on the fourth ventricle with resultant supratentorial hydrocephalus and periventricular cerebrospinal fluid (CSF) ooze [Figure 1]a and b. The mass appeared isointense on T1-weighted images with thick irregular peripheral enhancement [Figure 1]c and d. Dynamic contrast-enhanced MRI perfusion revealed the mass to be homogenously hypoperfused as compared to normal reference cerebellar white matter [Figure 2]a. MR-spectroscopy (TE135) revealed absent N-acetyl aspartate (NAA) within the mass lesion with a large lipid peak at 1.2 ppm [Figure 2]b. Multivoxel spectroscopy (TE30) revealed reduction of NAA without significant elevation of choline in the mass lesion [Figure 3].