Reason: F/u compare to previous. given R frontal GBM, evaluate for progressive dz given gait difficulty and encephalopathy History: please see above The patient is status post right frontal lobe surgery involving right superior frontal gyrus some of the right middle frontal gyrus and some of the adjacent right cingulate gyrus. Cerebral blood volume map is not convincing for elevated cerebral blood volume.A previously noted right frontal horn of lateral ventricle nodule now measures 19 x 9 mm coronal dimensions and previously measured 13 x 7 mm coronal dimensions. It has some heterogeneous enhancement. There are serpiginous low signal foci on susceptibility imaging present within this lesion. Cerebral blood volume map is not convincing for elevated cerebral blood volume.There is a nonenhancing nodule present along the posterior and superior aspect of the right frontal lobe resection site measuring 27 x 19 mm and axial dimensions and previously measuring 27 x 19 mm axial dimensions. It is not associated with contrast enhancement but is associated with some susceptibility effect. Additional small nodules are redemonstrated at the borders of the resection site measuring up to 3 mm. These were not present in February.There is a focus of signal hyperintensity involving the medial aspect of the right frontal lobe and cingulate gyrus anterior to the frontal horn of the right lateral ventricle currently measuring 27 x 18 mm in axial dimensions and previously measuring similar dimensions. This is not associated with susceptibility effect. Cerebral blood volume map is not convincing for elevated cerebral blood volume.A right-sided cerebellar lesion adjacent to the fourth ventricle which deforms the fourth ventricle measures 9 x 13 mm axial dimensions and is unchanged when compared to the previous exam. This was not present on the exam from last February. Cerebral blood volume map is not convincing for elevated cerebral blood volume. This was not present in February.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.Incidental note is made of partial empty sella
1.Since the prior exam a subtle ependymal lesion in the right lateral ventricle has definitively enlarged. This suspicious for neoplastic process.2.A right subendymal lesion at the fourth ventricle and lesions at the surface of the tumor resection site remain stable when compared to the prior exam and were not present in February.3.A right anteromedial frontal lobe lesion is stable since February.