GBM, on CCNU There has been no significant change in size or morphology of the resection cavity incorporating the right anterior temporal lobe, a portion of the right insula, and the right inferior frontal lobe. Compared to 3/25/2016 and 2/26/2016, extensive T2/FLAIR abnormality surrounding the resection cavity is not appreciably changed. Ex vacuo enlargement of the right lateral and the third ventricles is again noted. Punctate focus of diffusion restriction along the anterior medial aspect of the resection cavity is unchanged and consistent with treatment change.Nodular foci of enhancement along the medial aspect of the resection cavity/right frontal horn margin as well as along the margins of the bilateral lateral ventricles are slightly increased in prominence since 3/25/2016 and increased more so in prominence when compared to 2/4/2016.Otherwise, there is no new enhancing or T2 hyperintense lesion. Mild periventricular T2 hyperintensity along the left lateral ventricle is unchanged and probably related to treatment. Ventricular size and morphology are stable.The major intracranial arterial flow voids are preserved otherwise. There are small retention cysts in the maxillary sinuses. Chronic fluid signal in the right mastoid air cells is still present.
Nodular foci of enhancement medial to the resection cavity/right frontal horn margin as well as along the surface of the lateral ventricles demonstrate slight increase in prominence compared to several recent studies and are concerning. Of note, however, nodular foci of enhancement along the bilateral frontal horns were more prominent on more remote MRI study from 10/9/2015, presumably pre-Avastin therapy (which can be confirmed with history). Otherwise no evidence of a discrete recurrent mass at the resection site.