Clinical question: Malignant neoplasm of brain, unspecified site. Signs and symptoms: History of GBM status post TMZ/RT, surveillance scan. Signs and symptoms: Headache. Pre- and post enhanced brain MRI:No evidence of restricted diffusion.Examination demonstrates a large necrotic rim-enhancing mass in the right posterior temporal-parietal region with evidence of interval increased size since prior study. On axial postenhanced series isMass measures maximum of 40 x 28 mm in transaxial compared to prior study measurement of 33 x 26. There is a thick focus of rim enhancement along the superior/anterior aspect of necrotic tumor measuring 13 mm in thickness and 21 mm along the necrotic cavity wall. There is also subtle interval overall increased thickness of rim enhancing tumor since prior exam. Findings are suggestive of interval progression of disease. There is extensive surrounding vasogenic edema interval increased extent since prior exam.Previously noted small thin rim enhancing lesion at the site of prior surgical resection in the right frontal lobe demonstrate decreased size and decreased surrounding vasogenic edema. No definitive evidence of tumor.Ventricular system remains within normal heads with maintained midline and without change.
1.Interval increased size of a necrotic rim-enhancing tumor in the right hemisphere. There is generalized as well as focal interval thickening of rim enhancement of tumor and surrounding edema consistent with progression of disease as detailed/measured above.2.Interval decreased size and reduced surrounding edema at the site of right anterior frontal lobe resection cavity since prior exam.