 Redemonstrated are postoperative changes of a right parietal craniotomy with resection of a previously demonstrated enhancing tumor along the resection cavity. The subadjacent epidural fluid collection confined to the right parietal-occipital flap with mild mass effect on the adjacent parenchyma has decreased slightly in size now measuring 14 mm in thickness compared to 16 mm previously. The resection cavity itself has become slightly FLAIR hyperintense relative to the prior examination which may reflect accumulated debris or blood product. Restricted diffusion surrounding the resection cavity has diminished.There has been interval development of nodular peripheral enhancement along the resection cavity and involving the ependyma of the occipital and temporal horn of the right lateral ventricle. This ependymal enhancement first becomes apparent back on the 7/21/2015 MRI. Parts of the new nodular rim enhancement show increased relative cerebral blood volume. Again seen is persistent T2/Flair signal surrounding the resection cavity in the right temporal, parietal and occipital lobes. This FLAIR signal has slightly progressed in the inferior right temporal gyrus. Also redemonstrated is thickening and T2 hyperintensity of the right medial temporal lobe structures, similar to prior, and concerning for disease involvement.An equivocal small focus of restricted diffusion in the left periventricular region adjacent to the occipital horn is nonspecific. The ventricles may be mildly larger than on the prior exam. There is no midline shift.There is minimal mucosal thickening in the bilateral maxillary sinuses. The rest of the paranasal sinuses are unremarkable. There is fluid in the right mastoid air cells.
Post-surgical changes of a right parietal craniotomy for resection of recurrent GBM are seen. Progressive nodular peripheral enhancement within the parenchyma along the resection cavity is evident on today's exam. Given that these areas of new nodular enhancement demonstrate elevated rCBV, and in the context of slowly progressive ependymal enhancement, the findings are concerning for progression of disease. 