Male, 42 years old, with grade 3 glioma recently started on Avastin plus CCNU, new regimen since prior MRI. Evaluate for interval changes. Redemonstrated is evidence of prior tumor resection with cavities in the right anterior temporal lobe and the inferior right frontal lobe. Evidence of prior stereotactic biopsy is also seen.Since the prior examination, marked T2 hyperintensity, mass effect and enhancement within the right frontal lobe and insula have dramatically improved. Mass effect has essentially resolved and only mild patchy enhancement persists. An area of enhancement along the right lateral ventricular atrium seen on the prior examination has also resolved. Within this area of general improvement, there has been an increase in diffusion restriction.The left cerebral hemisphere, brainstem and cerebellum remain uninvolved by tumor. No new lesions are seen. The size and morphology of the ventricular system have recovered to that seen on the pre-progression examination of 8/5/2015.
A significant interval response to therapy is seen with much reduced enhancement, T2 signal abnormality and mass effect centered on the right frontal lobe. Progressive diffusion restriction within this tissue likely represents a treatment effect.