Male, 76 years old, history of GBM with recurrence. Preoperative planning for resection. Evidence of prior left temporal craniotomyis again seen. A small resection cavity within the anterior left temporal lobe remains visible.Surrounding the resection cavity is a thick rim of heterogeneous but predominantly solidly enhancing tissue which extends through the entire lateral aspect of the temporal lobe. Superiorly it reaches as far as the operculum and insula. Since the prior examination, this lesion has increased in overall size now measuring up to 46 x 32 mm (image 81 series 301), previously 37 x 28 mm. Extensive T2 hyperintensity surrounds this lesion essentially filling the left temporal lobe with extension posteriorly into the occipital lobe and superiorly into the operculum, insula, internal capsule and parietal lobe. The geographic extent of this signal abnormality is also progressed.No areas of pathologic enhancement are suspected discontiguous with the above-mentioned dominant lesion. The left lateral ventricle is partially effaced. The right lateral ventricle remains of normal caliber. Elsewhere, scattered foci of white matter T2 hyperintensity are seen, a nonspecific finding which may reflect microvascular ischemic disease.
Interval increase in size of a large enhancing lesion within the left temporal lobe.