72-year-old female with GBM. Expected postoperative findings of right temporal and frontal craniotomy related to subtotal resection of tumor. Within the right temporal lobe there is redemonstration of remaining tumor which demonstrates predominantly T1 hypointense/T2 hyperintense signal with surrounding T2/FLAIR hyperintensity likely representing residual necrotic tumor. There is surrounding T2/FLAIR hyperintensity compatible with vasogenic edema which is decreased in extent from prior study. Post contrast images of tumor demonstrates rim enhancement and the mass measures 4.8 cm x 4.0 cm (series 12, image 17) which is increased in size from prior study. However there is decreased mass effect upon the temporal horn of the right lateral ventricle with decreased effacement of the CSF spaces including the ambient and quadrigeminal cistern.Within the right frontal lobe there is an additional necrotic tumor demonstrating predominantly T1 hypointense signal centrally and heterogeneous T2 signal compatible with necrosis. The tumor demonstrates irregular rim enhancement on postcontrast images and measures 3.0 cm x 1.8 cm (series 12, image 10) minimally decreased from prior study. In the interval a new collection immediately lateral to the tumor has developed which demonstrates predominantly homogeneous T1 and T2/FLAIR hyperintensity with surrounding rim of low T2/FLAIR intensity and no enhancement; this likely represents blood products in the chronic stage and measures 2.6 cm x 2.3 cm (series 12, image 10). There is T2/FLAIR hyperintensity predominantly surrounding the tumor which is decreased in extent from prior study with resultant decrease in mass effect and effacement of the right lateral ventricle; there is a leftward midline shift of 5 mm on the current study, previously 8 mm.On the perfusion images, there is increased signal predominantly along the peripheral posterior lateral aspect of the right temporal lobe lesion and along the peripheral anteromedial aspect of the right frontal lobe lesion. This may represent viable tumor versus compressed brain parenchyma. No increased central signal is identified however within the lesions compatible with necrosis. No new intracranial mass lesions are noted. Scattered subcortical and periventricular white matter T2/hyperintense foci are similar to prior study compatible with chronic small vessel ischemic disease.The paranasal sinuses and mastoid air cells are clear. The orbits are unremarkable.
1. Mixed interval change in size of intra axial lesions, specifically, slightly increasing size of the necrotic portion of the right temporal lobe however with decreasing mass effect and vasogenic edema and decreased size of the necrotic tumor in the superior aspect of the right basal ganglia with decreasing mass effect and midline shift. 2. There has been interval development of a new collection immediately lateral to the lesion which most likely represents chronic hemorrhage.3. Increased signal on the perfusion images along the peripheral aspect of the lesions may represent viable tumor versus compressed brain parenchyma. There is no increased signal centrally within the lesion compatible with necrosis.