Clinical question: Newly diagnosed GBM status post biopsy only; please evaluate extent of brain tumor. Signs and symptoms: Difficulty speaking. Pre- and post enhanced brain MRI:Examination demonstrates a large focus of vasogenic edema in the left mid and posterior temporal lobe surrounding a large necrotic enhancing tumor. On postenhanced images the tumor measures approximately 51 x 30 mm in transaxial dimensions. Compared to prior study there is interval increased size of tumor which measure that 30 x 24 mm in transaxial dimensions. This is also noticeable interval increased surrounding mesenteric edema and mass effect. The tumor is inseparable from the temporal horn and the trigone of the left lateral ventricle. On coronal images there is significant bulge of tumor into the left lateral ventricle.There is evidence of a small craniotomy in the left posterior temporal-occipital region with underlying subtle parenchymal edema believed to represent site of previous surgical approach for biopsy. There is expected minimal superficial parenchymal enhancement at the site and with linear enhancement extending to the posterior-lateral aspect of tumor along the surgical path.Mildly prominent lateral ventricles without interval change since prior exam or deviation of the midline. Few nonspecific foci of FLAIR hyperintensity in the subcortical and periventricular white matter of cerebral hemispheres although nonspecific considering patient's stated age of 72 likely representing mild chronic nonhemorrhagic small vessel ischemic strokes.
1.Interval increased size of a necrotic rim enhancing tumor in the left mid to posterior temporal lobe and its surrounding vasogenic edema since prior exam. The enhancing tumor measures at 51 x 30 mm compared to prior study measurement of 30 x 24.2.Expected postoperative changes of prior tumor biopsy as detailed.3.Unremarkable exam otherwise and evidence of only minimal chronic nonhemorrhagic small vessel ischemic strokes.