Malignant neoplasm of brain, unspecified [C71.9], Reason for Study: ^Reason: Eval GBM. Pt on TMZ. History: GBM. Considering the difference in scan angle, the size, enhancing characteristics and the extent of surrounding edema of the right hemispheric GBM do not show any significant interval changes since prior scan.However, there are new ill defined several enhancing foci on the right basal ganglia mesial aspect of the main tumor mass which suggest progression of tumor. The degree of midline shift toward left side appears to be slightly lessen than prior exam (8.3mm, prior 9.2mm at the level of foramen of Monroe on coronal plane) but could also be related to scan direction.Although not quantitative, gradient echo images show more susceptibility lesions within the enhancing tumor especially on the anterior and lateral aspect indicating hemorrhagic foci. The ventricles, sulci and cisterns are unchanged. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.
1. Interval development of several new ill defined enhancing foci mesial aspect of the main tumor indicating possible tumor progression.2. Interval increase number of susceptibility lesions on the anterior and lateral aspect of the tumor indicating possible newly developed hemorrhagic foci.3. Overall right hemispheric GBM size, mass effects, surrounding edema and MR enhancement patterns do not show any significant interval change since prior scan. 