Clinical question: Secondary GBM on Avastin. Signs and symptoms: GBM. Pre and post enhanced brain MRI:Examination demonstrated a large focus of FLAIR/T2 hyperintensity in the left anterior and mid temporal lobe with extension into left remaining inferior frontal lobe and extensive extension medially into the left basal ganglia and left periventricular white matter. Findings demonstrate regional mass effect and with very irregular configuration. Finding is consistent with patient's known GBM. There is no convincing evidence of any interval change in the signal intensity or extent/size of this lesion. On post enhanced images there is a focus of enhancement in the left inferior frontal component of above described finding which minimally extends into the left anterior temporal parenchyma similar to prior exam. All measurements of this focus of enhancement appear fairly similar to prior exam and without convincing evidence of change in size.There is an additional isolated small focus of enhancement in the left periventricular white matter component of this lesion measuring approximately 7 mm in transaxial dimensions which is less conspicuous compared to prior study however without definitive change in size.Above findings results in regional mass effect and effacement of adjacent cortical sulci, subtle mass effect in the left anterior aspect of the lateral ventricle similar to prior exam and without deviation of midline.Stable postoperative changes of left inferior frontal partial lobectomy for removal of tumor. Mild dilatation of the lateral ventricles similar to prior exam.Stable patchy and confluent FLAIR hyperintensity in the left hemisphere which is believed to represent post treatment changes. Possibility of overlapping chronic small vessel ischemic strokes cannot be excluded. No detectable new foci of signal abnormality or new foci of abnormal enhancement since prior exam.
1.No evidence of an acute or definitive evidence of new finding since prior exam.2.A large left hemispheric anterior temporal, left inferior frontal, left basal ganglia and left periventricular white matter mass with 2 internal noncontiguous foci of enhancement and its associated mass effect remains fairly similar to prior study. The larger focus of enhancement in the left inferior frontal lobe measures at 19.5 x 17 mm and a 7mm focus of isolated enhancement in the left periventricular white matter component of tumor similar to prior exam.