Clinical question: 63-year-old male with GBM. Off all treatments. Previously was on Avastin. Signs and symptoms: GBM. Pre and postcontrast enhanced brain MRI:Diffusion weighted images demonstrate a punctate focus of restricted diffusion in the subcortical white matter of the right superior temporal gyrus posteriorly (diffusion-weighted series 5 image 18).Examination demonstrate a large focus of FLAIR hyperintensity in the pattern of vasogenic edema however without mass effect in the right hemisphere extending from high convexity right posterior frontal to right parietal and extensively in the right posterior temporal region consistent with gliosis and with ex vacuo dilatation of right trigone of lateral ventricle. Minimal hemorrhagic changes in the right posterior temporal at the site of prior surgical intervention is again noted. No appreciable change since prior exam.Post enhanced images demonstrate no evidence of residual or recurrence of tumor. A very thin linear enhancement traversing the posterior edge of surgical cavity is identical to prior exam.Small focus of periventricular FLAIR hyperintensity in the left hemisphere similar to prior exam and highly suggestive of treatment changes.Subtle FLAIR hyperintensity in the pons similar to prior study and could represent posttreatment change or chronic small vessel ischemic stroke. Tiny small focus of FLAIR hyperintensity in the right cerebellum without enhancement or interval change since prior exam is also noted.Slight prominence of lateral ventricles with maintained midline is similar to prior exam.
1.Punctate focus of restricted diffusion in the right superior temporal sinus posteriorly.2.Stable post operative and treatment changes of right posterior temporal lobe tumor without evidence of tumor recurrence as detailed.