Clinical question: Evaluate growth of secondary GBM. Patient on Avastin. Signs and symptoms: Secondary GBM. Pre and postcontrast enhanced brain MRI:Postoperative changes of a right frontal tumor resection and with resultant ex vacuo dilatation of the adjacent right lateral ventricle remains similar to prior study.Large focus of FLAIR hyperintensity anterior to the surgical cavity and along the right frontal cingulate gyrus measures nearly identical to prior exam and without convincing evidence of abnormal enhancement.Flair and T2 hyperintensity surrounding and within the right frontal horn demonstrate subtle interval increased size and with new evidence of enhancement since prior exam. Finding is highly suggestive of tumor.A second well demarcated masslike lesion with FLAIR hyperintensity along the posterior superior aspect of the resected cavity measures slightly larger in size since prior exam and with evidence of subtle mass effect. The largest AP axis of this lesion measures almost 27 mm compared to prior study measurement of 23. This change however could be secondary to slice positioning. This finding however demonstrate enhancement which is new since prior and best appreciated on axial post enhanced series 11 images 4 and 5. Constellation of findings are suggestive of tumor. Focus of hemorrhagic FLAIR hyperintensity along the interhemispheric aspect of the left hemisphere demonstrate evidence of mineralization and without change since prior exam. It however demonstrate subtle enhancement on post infused images which is more conspicuous on current study however not significantly changed when compared with earlier exams.
1.FLAIR and T2 hyperintensity surrounding and within the right frontal horn of lateral ventricle demonstrates subtle interval increased size and with evidence of new enhancement as detailed. Finding is suspected of tumor.2.Well-demarcated focus of FLAIR hyperintensity with restricted diffusion along the posterior superior aspect of the surgical cavity in the right frontal demonstrate evidence of new enhancement and suspected for tumor.3.Stable focus of FLAIR hyperintensity with mineralization and subtle enhancement along the interhemispheric aspect of the left frontal parietal lobe as detailed above. 