Nivolumab treatment for glioblastoma. There has been marked interval increase in size of multiple enhancing intraparenchymal masses with elevated CBV. The heterogeneously enhancing soft tissue mass adjacent to the left temporal resection cavity measures 3.6 x 3.3 cm, previously approximately 3.2 x 2.6 cm. The mass in the inferior frontal lobe measures 3.0 x 2.7 cm, previously 0.9 x 0.7 cm, with mass effect on the left lateral ventricle near the foramen of Monro. While the foramina of Monro appear to be patent, the ventricular system appears to have increased in size diffusely. This inferior frontal mass extends laterally with heterogeneous enhancement extending to the left temporal resection cavity. This inferior frontal mass also abuts the prechiasmatic left optic nerve and surrounds the A1 segment of the left anterior cerebral artery. The left MCA is not clearly discernible, although distal MCA branches are appear to be patent. The heterogeneously enhancing mass along the left posterior temporal lobe has also increased in size, measuring 2.2 x 4.1 cm, previously 1.6 x 2.5 cm. Just medial to this lesion, there is a markedly increased thick heterogeneous rim enhancement mass that measures approximately 8.5 x 3.1 cm, previously approximately 1.5 x 1.0 cm. Associated with each of these growing lesions are numerous punctate and confluent foci of susceptibility artifact, compatible with punctate hemorrhage and/or angiogenesis. There is also extensive T2 abnormality throughout the white matter of the left cerebral hemisphere, corpus callosum, and periventricular white matter on the right, as well as Wallerian degenerative in the left brainstem. There is no evidence of acute brain parenchymal infarction. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.
Marked interval progression of the left hemisphere glioblastoma.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.