Clinical question: Secondary GBM. Signs and symptoms: Secondary GBM. Pre-and post-enhanced brain MRI:Negative diffusion weighted images for restricted diffusion.Examination redemonstrates a large focus of flair/T2 hyperintensity involving the left anterior temporal and left inferior frontal lobe and with extension into the left basal ganglia consistent with patient's previously known tumor. There is no appreciable change in the extent or size/morphology of this finding since prior study. On post enhanced images however previously noted large focus of enhancement representing tumor in the right inferior frontal lobe demonstrate interval decreased size since prior exam. This finding on current exam measures at 18 times 19-mm compared to prior study measurement of 19.3 x 23-mm. This focus of enhancing tumor on sagittal SPGR post enhanced series measured maximum of 25 mm in (cc) compared to today's exam measurements of between 13.7 to 17.8-mm.A second smaller satellite focus of enhancement demonstrate minimal interval decrease size however with significantly less intensity of enhancement. The lesion measured approximately at 6 x 6.3-mm compared to current study measurement of 5.5 x 5 mm. There is no detectable additional foci of parenchymal or leptomeningeal enhancement.Flair hyperintensity in the periventricular white matter of bilateral cerebral hemispheres (left greater than right) consistent the residual peritumoral edema and post-treatment/radiation change without appreciable interval progression.
1.Interval decreased size of focus of enhancing tumor in the left inferior frontal lobe compared to prior study as detailed/measured above.2.Minimal interval decreased size of a small satellite focus of enhancement in the left hemisphere however with significantly less intensity of enhancement since prior exam as detailed/ measured above.3.Stable extensive focus of nonenhancing flair hyperintensity with increased volume in the left frontal, left anterior temporal and left inferior frontal lobe. 