56-year-old female patient with glioblastoma multiforme. Evaluate for GBM status post RT/TMZ/bev. 4 week Redemonstration of postsurgical changes related to a right parietotemporal craniotomy for partial tumor resection from the right temporal lobe. Again seen is extensive enhancement surrounding the resection cavity, with the area of thick enhancement appearing mildly increased particularly along the superior margins of the tumor within the right temporooccipital lobe and extending to the right splenium. However, there is significant interval decrease in surrounding abnormal T2 signal along with diffusion abnormality, predominantly within the superior aspect of the right temporal lobe and parietooccipital lobe. This results in decreased mass effect and midline shift which now measures approximately 4 mm, previously 13 mm. Right uncal herniation is improved. An additional satellite nodule along the lateral surface of the right lateral temporal lobe is unchanged. Prominent left temporal horn periventricular T2 signal is unchanged. Linear and nodular susceptibility artifact surrounding the resection cavity is not significantly changed.
1. Post-surgical changes in the right temporal lobe related to partial resection of known GBM. Compared to 5/1/2015, there is significant decrease in FLAIR hyperintensity/edema particularly superior to the enhancing lesion consistent with response to Avastin therapy. There is however some interval increase in thick enhancement particularly surrounding the trigone of the right lateral ventricle, which given recent radiation therapy may represent treatment change; close follow-up, however, is recommended. 2. Improvement in mass effect, midline shift, and right uncal herniation.3. Unchanged right lateral temporal lobe satellite lesion.