Most supratentorial subependymomas have characteristic appearance on MR imaging, being homogeneous with no or minimal enhancement, which differentiates them from other supratentorial intraventricular tumors and also from infratentorial subependymomas. However, the large size, high vascularity, heterogeneous enhancement and presence of symptoms, should not persuade the radiologist to exclude it from his differential diagnosis. It is of paramount importance to consider supratentorial subependymomas in the differential diagnosis of supratentorial lesions, even if their radiological features were atypical.

From the manuscript

Unusual Appearance and Presentation of Supratentorial Subependymoma in an Adult Patient

Abstract
We report a case of a large, heterogeneously enhancing, pathologically proven, supratentorial subependymoma in a 31-year-old male patient presenting with headache, nausea and vomiting as well as gait disturbances. Although most supratentorial subependymomas have distinctive MR features, our case demonstrated imaging findings that made it indistinguishable from other more aggressive malignant supratentorial intraventricular lesions. It is of paramount importance to consider supratentorial subependymomas in the differential diagnosis of supratentorial lesions, even if their radiological features were atypical.