GBM on Avastin. There are postsurgical changes of right craniotomy for tumor resection including mild dural thickening and enhancement. The bulk of the heterogeneously enhancing right cerebral hemisphere mass, centered in the deep grey matter nuclei and frontal lobe, appears to have increased in size, with scattered areas of restricted diffusion and susceptibility effect. However, the more peripheral necrotic portions and the surrounding high T2 signal that likely represents at least to some extent vasogenic edema have diminished. The right lateral ventricle and perhaps the third ventricle have increased in size, but the left lateral ventricle remains distended. There is persistent leftward midline shift of approximately 14 mm and right uncal herniation. There is no evidence of acute territorial infarction or hemorrhage. The major cerebral flow voids are intact. The orbits are grossly unremarkable.
The bulk of the enhancing portions of the large right cerebral hemisphere glioblastoma appears to have increased in size, which may be due to tumor progression, but the necrotic components and associated vasogenic edema has diminished, which may be attributable to Avastin.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.