Diagnosis: Malignant neoplasm of brain, unspecifiedClinical question: Eval GBM. Pt is on a trial of HSPPC96 vaccine.Signs and Symptoms: GBM. There is redemonstration of a left temporal lobe mass is T2 signal abnormality measures 68 x 43 mm in axial dimensions and appears to have extended a little more posteriorly on the current exam relative to the prior exam. A cystic component along its inferior anterior aspect appears smaller on the current exam. The cystic component currently measures 17 x 18 mm axial dimensions and previously measured 25 x 28 mm axial dimensions. On sagittal imaging the enhancing component currently measures 59 x 40 mm and previous and measured 36 x 52 mm. Cerebral blood volume map demonstrates elevated cerebral blood volume in the central portion of the mass. Serpiginous flow-voids are identified within the central portion of the tumor on susceptibility weighted imaging.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Since prior exam the patient's left temporal lobe mass has enlarged and appears to have infiltrated further back posteriorly. It is associated with increased cerebral blood volume suggesting increased microvascular within the tumor.