Known progression of GBM, evaluate tumor burden Again seen are postoperative changes related to a right parietotemporal craniotomy for partial tumor resection from the right temporal lobe. There is been evolution of the resection cavity with decrease in associated blood products. Compared to prior MRI from 3/30/2015, there is mild interval increase in masslike FLAIR hyperintensity and enhancement surrounding the right temporal resection cavity indicative of tumor progression. Again seen are additional satellite nodules including along the lateral surface of the right inferior temporal lobe. There is increased mass effect compared to prior MRI with midline shift measuring 13 mm, previously 10 mm at the level of the inferior aspect of the foramen of Monro. There is also increased effacement of the right lateral ventricle. Uncal herniation is again noted and slightly progressed in the interval. Again seen is prominent periventricular flair hyperintensity surrounding the left temporal horn which may be related to entrapment. There is restricted diffusion associated with the tumor as seen previously particularly along the right splenium which appears slightly increased and may represent more hypercellular tumor.
1. Compared to 3/30/2015, there is been evolution of postoperative changes related to partial resection of known GBM and evidence of mild interval tumor progression. 2. There is mild worsening of mass effect including increased midline shift and right uncal herniation. 3. Slight interval enlargement of the left lateral ventricle indicative of entrapment. 4. Worsening mass effect is not significantly changed since more recent CT from 4/28/2015.