34-year-old man with history of left frontal glioblastoma status post craniotomy, resection, radiation therapy completed 10/28/2016, and on chemotherapy. There are postoperative findings from left frontal lobe surgery and resection of recurrent tumor. A slightly lobulated, fluid collection in the surgical cavity appears stable in size. Comparison to prior imaging is limited due to changing order of the post-contrast sequences. There is heterogeneous enhancement posterior to the surgical cavity which crosses the midline via the genu of the corpus callosum. This enhancement has slightly decreased in thickness and appears less confluent compared to the prior examination, particularly along the corpus callosum, although this in part could relate to differences in technique. Surrounding FLAIR and T2 white matter hyperintensity has minimally increased in extent along the left lateral frontal lobe from the prior examination (6/22). There are no additional abnormal remote foci of enhancement. A few, nodular foci of diffusion restriction within the posterior margin of the left frontal lobe resection cavity (3/20) are more conspicuous than the prior examination.Additional right frontal periventricular FLAIR signal is unchanged and nonspecific. Punctate, scattered foci of susceptibility artifact in the bilateral centrum semiovale and right parietal lobe are unchanged. The ventricles and basal cisterns are stable in size and configuration. There is no significant mass effect or midline shift. The major cerebral flow voids are intact. No diffusion abnormality to suggest acute infarct.The sella and orbits are grossly within normal limits. The paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.
1.Comparison of postcontrast imaging somewhat limited by acquisition of the series at different times relative to the prior exam. The heterogeneously enhancing tumor appears slightly less thick along the corpus callosum, although nodular diffusion abnormality posterior to the resection cavity appears more conspicuous. Overall, there is no significant progression of tumor but continued close follow-up is warranted.2.Slightly increased extent of surrounding white matter T2 hyperintensity which could represent vasogenic edema, post radiation change, and/or tumor.