Diagnosis: Malignant neoplasm of brain, unspecifiedClinical question: Eval GBM. 1 mo post-RT MRI.Signs and Symptoms: GBM.Comments: GBM. 1 mo post RT. | There is an 80 by the 2 mm mm sagittal dimension heterogenously enhancing mass in involving the deep white matter of the right frontal lobe and the adjacent subcortical white matter of the right parietal lobe . This previously measured 61 x 40 mm sagittal dimensions. There is adjacentT2/FLAIR signal hyperintensity compatible with vasogenic edema in an area measuring 118 x 59 mm mm axial dimensions. This previously measured 97 x 62 mm axial dimensions. There are satellite foci of enhancement in the adjacent brain. There is susceptibility effect within the mass. There is T2 signal hyperintensity present in the right midbrain and pons on the current exam which was not clearly present on the prior. There is associated mass effect with approximately 13 mm shift of the midline towards the left on the current exam which was approximately 11 mm on the prior exam. There is associated uncal herniation which was also previously present. There is also associated dilation of the left lateral ventricle associated with subfalcine herniation and there is a mild degree of transtentorial herniation also present.The patient is status post recent right sided craniotomy. There is an underlying subdural collection measuring up to 5mm thickness.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The distal right vertebral artery appears to be hypoplasticThe visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Since the prior exam the patient's right hemispheric mass consistent with glioblastoma has enlarged and is associated with more mass effect on the current exam versus the prior exam. There is associated uncal, transtentorial and subfalcine herniation present. There appears to be some infiltration into the right upper brainstem on the current exam which was not previously present.2.A right-sided subdural collection is now smaller on the current exam.