Figure 2

An elderly patient was referred with hemiparesis and suspected to have a stroke. MRI demonstrated a lesion in the left hemisphere which on (A) T1 weighted axial image post gadolinium at 1.5 T is shown to have a solid and ring enhancing portion. (B) The associated ADC map shows considerably reduced diffusion at the site of the solid portion of the lesion with increased diffusion due to vasogenic oedema in the white matter surrounding the mass. (C) Single voxel proton MRS of the lesion yields an abnormal spectrum with a large lipid and lactate peak, reduced NAA, reduced Cr and slightly elevated Cho. This pointed to a metastasis, glioma or lymphoma as opposed to an abscess. There was time to optimise the patient for surgery and begin steroid treatment before the lesion was resected and confirmed to be a renal cell carcinoma.