Clinical question: Evaluate GBM, patient TMZ, Avestin, NovoTTF. Signs and symptoms: GBM. BMD. Pre and post enhanced brain MRI:Examination demonstrates mild interval decreased size of a large necrotic right hemispheric frontal GBM since prior exam and with decreased surrounding vasogenic edema since prior study. The largest transaxial dimensions of this necrotic tumor with thick irregular rim of enhancement are at 44 x 33 mm compared to prior study the measurements of 56 x 41 mm. Changes results in better visualization of right hemispheric cortical sulci and without evidence of midline shift.Several additional remote foci of FLAIR/T2 hyperintensity and enhancement in the corpus callosum and extensively in the left hemisphere demonstrate varying degrees of interval improvement and progression since prior study. For example a previously noted focus of enhancement in the posterior left occipital lobe which measured at 9 x 10 mm on prior exam has increased to 17 x 18 mm. A smaller additional focus of enhancement in the left occipital lobe which measured at 3.8 mm on prior exam has increased to approximately 9 mm current study. Focus of enhancement in the left anterior temporal lobe which measures 11 x 7 mm on prior exam demonstrates significant interval decreased size and measuring at approximately 8 x 5 mm on current study. Focus of enhancement in the immediate periventricular white matter of the left temporal lobe which measured at 6 mm in thickness has decreased and measuring 2.3 mm on current exam.Few of the additional remote foci of enhancement demonstrate interval improvement since prior study. Multiple transversely oriented rim-enhancing lesions in the corpus callosum demonstrate interval decreased size. The largest lesion in the anterior body of corpus callosum measuring approximately at 34 x 14 mm on prior exam has decreased to 33 x 7 mm in size.The ventricular system remains within normal size and midline is maintained. The CSF spaces/cisterns remain patent.There is no detectable new foci of FLAIR/T2 hyperintensity or new foci of abnormal enhancement since prior exam.
1.Interval decreased size and surrounding vasogenic edema and regional mass effect of a large right frontal GBM as detailed/measured about.2.Interval progression as well as interval improvement of multiple additional foci of enhancement consistent with multifocal focal GBM as detailed/measured above.