34 years, Male, GBM. Most recently underwent resection w/ intratumoral injection of Ad-RTS-hIL12. Compared to 1/4/2016 and 3/7/2016, there is slight gradual increase in size of the heterogeneous nodular enhancement along the inferior aspect of the left frontal resection cavity which now appear to extend to the surface of the left frontal horn. There was a small ovoid peripherally enhancing lesion in the inferior left frontal lobe which appeared separate from the larger area of enhancement on 1/4/2016 and now demonstrates coalescence into the relatively larger area of enhancement. The cystic/peripherally enhancing areas slightly more laterally in the left anterior frontal lobe also demonstrates slight enlargement. Expansile FLAIR hyperintensity involving the left anterior frontal cortex also demonstrates subtle gradual increase in prominence when compared to the prior studies. There is mild associated restricted diffusion. These findings are suspicious for tumor progression. Overall no major change in the degree of FLAIR hyperintensity in the left frontal lobe extending into the right frontal lobe. No significant new mass effect, midline shift, or herniation is appreciated. No evidence of acute ischemia or new hemorrhage. Chronic blood products associated with the left frontal resection cavity are again seen, which also limit perfusion sequence. No hydrocephalus.
Compared to 3/7/2016 and 1/4/2016, there are findings suspicious for gradual tumor progression involving the left frontal lobe inferior to the left frontal resection cavity. Posttreatment change while possible seems less likely, especially given the masslike cortical thickening with mild restricted diffusion. Suggest continued close follow-up.