Glioblastoma. Status post resection and chemoradiation treatment. The study is limited by patient motion. The left temporal resection cavity has regressed in size. There is contrast enhancement extending from anterior-superior surgical margin that measures in the axial plane 2.0 cm x 0.8 cm and craniocaudally 1.0 cm. There is confluent T2-hyperintensity in the medial left temporal lobe associated with mild expansion which has mildly improved with less extension toward the subinsular region and the left deep nuclei. Encephalomalacia in the anterior aspect of the left temporal lobe has evolved as well. The remainder of the brain shows no abnormal contrast enhancement or mass-effect. Somewhat linear T2-hyperintensity in the right parietal white-matter is unchanged. There is no midline shift or brain herniation.There is mild ethmoid mucosal thickening. The orbits are grossly unremarkable. The fluid underneath the left temporal craniotomy flap is improved and the overlying soft-tissue swelling is also improved. Given the degree of motion as well as susceptibility effect in the treatment bed, it is difficult to accurately assess the perfusion characteristics of the contrast enhancement focus. However, there is a suggestion of mildly increased corrected cerebral blood volume correlating with the infiltrative T2 signal in the medial aspect of the left temporal lobe.There is fluid signal intensity in both mastoid air cells, more pronounced on the left, might be congestive or inflammatory. There is a retention cyst in the right side of the nasopharynx, which is unchanged.
1.The examination is at least moderately limited by patient motion.2.Contrast enhancement along the anterior-superior surgical margin is of unknown significance. This is nonspecific and may represent residual tumor or posttreatment change.3.Confluent T2-hyperintensity and mass-effect in the medial aspect of the left temporal lobe have slightly improved since January 2016 and may represent evolving posttreatment change admixed with infiltrating tumor.