Male, 64 years old, with GBM, status post two cycles immunotherapy. Postoperative changes are again seen in left occipital lobe. A small area of encephalomalacia is unchanged. Enhancing nodules are redemonstrated, including two small nodules and a dominant nodule with associated rim-enhancing cyst. The smaller nodules are stable or at most minimally increased in size. The dominant nodule, however, has mildly increased in size, now measuring up to 20 mm in axial short axis, previously 17 mm. As before, enhancement from this lesion spreads to the ependyma of the left atrium. Susceptibility artifact somewhat limits evaluation on perfusion sequences, but there is clear elevated rCBV correlating to the dominant nodule and at least one of the smaller nodules.T2 hyperintensity surrounding this lesion has progressed with further extension of this signal abnormality anteriorly into the temporal lobe. The left splenium of the corpus callosum is involved, but no definite contralateral spread is seen. The left lateral ventricle is partially effaced similar to prior. The remaining ventricles are unremarkable.
Multiple nodular enhancing lesions are redemonstrated within the left parieto-occipital junction. The dominant lesion demonstrates a mild interval increase in size. Extensive T2 hyperintensity surrounding these lesions has also progressed. Given that subtle progressive findings were suspected on the prior examination, the possibility that this represents slowly growing tumor is raised.