43 years, Male, glioblastoma on TMZ + IDO inhibitor.. Again seen are postsurgical changes of right-sided craniotomy for resection of right temporoparietal mass. There is FLAIR hyperintensity in the right posterior temporal and occipital lobes along the inferior and posterior aspect of the resection cavity, which has increased since prior from 6/29/2016. Masslike FLAIR hyperintensity involving the right periatrial white matter, extending across the corpus callosum into the left parietal white matter has also increased in the interval. Slight further increase in FLAIR hyperintensity superiorly into the right posterior frontal lobe including the right precentral gyrus is also noted. Areas of mild restricted diffusion are present within the area of increased FLAIR hyperintensity and enhancement with also corresponding areas of elevated cerebral blood volumes. Some of the FLAIR hyperintensity surrounding the resection cavity as well as in the bilateral posterior periventricular region however demonstrates corresponding decreased CBV. Postcontrast images also demonstrate interval increase in enhancement surrounding the posterior inferior aspect of the resection cavity, along the ependymal surface of the occipital horn of the right lateral ventricle, extending across the corpus callosum, and into left periatrial region. There is also interval increase in ependymal enhancement surrounding the left frontal horn as well as along the fourth ventricle wall.Extra-axial lesion in the left middle cranial fossa which likely represents an arachnoid cyst is again seen and again demonstrates nonsuppression of signal on the FLAIR sequence which may be related to prior hemorrhage. No significant change in the interval. Extra-axial collections along the bilateral cerebral convexities demonstrate slight interval decrease in size as well as change in signal characteristics compatible with evolution. The relatively larger right-sided subdural collection measures up to 8 mm in thickness previously up to 11 mm, measured similarly. Associated mild mass effect on the right frontal sulci is also improved.There is no midline shift or uncal herniation. Ventricles are not significantly changed in size; no hydrocephalus.Unchanged small left frontal scalp lesion which may represent a sebaceous cyst.
1. Compared to 6/29/2016, there is interval increase in T2/FLAIR hyperintensity in the right posterior temporal and occipital lobes along the inferior and posterior aspect of the resection cavity with also increased T2/FLAIR hyperintensity extending into the right posterior frontal lobe, across the corpus callosum, and into the left parietal lobe. These findings are even more pronounced when compared to 4/28/2016. There is also interval increase in areas of enhancement and restricted diffusion with elevated cerebral blood volumes in the above-mentioned regions. Overall findings are suspicious for tumor progression. 2. Abnormal enhancement is noted to extend to the ependymal surface, which was present previously. There is however interval increase in periventricular enhancement surrounding the left frontal horn as well as along the fourth ventricle wall, findings which are suspicious for ependymal tumor spread.3. Decrease in size of bilateral subdural collections. 4. Left middle cranial fossa arachnoid cyst with complex fluid/blood products again seen.