Glioblastoma multiforme on Avastin. Again seen are postsurgical changes of right temporoparietal craniotomy for partial tumor resection in the right temporal lobe. There is persistent nodular enhancement surrounding the right temporal resection cavity, which is not significantly changed. At least 3 distinct separate nodular foci of enhancement more anteriorly and laterally involving the right temporal lobe cortex are more distinct than on the prior examination, and the largest of these lesions now measures 12 x 11 in greatest axial dimensions with peripheral nodular enhancement. Perfusion imaging in this region did not demonstrate any significantly increased cerebral blood volume.There is also no significant change in extent of T2/FLAIR hyperintensity surrounding the resection cavity, as well as to a lesser degree in the left cerebral white matter, as well as along the occipital horns. Restricted diffusion related to treated tumor is not significantly changed. There is no significant change in size of the ventricular system, which remains prominent. No evidence of acute infarct or acute hemorrhage. No new significant mass effect, midline shift, or herniation.
More distinct foci of enhancement within a previously seen area of ill-defined enhancement anterolateral to the resection cavity does not demonstrate hyperperfusion, and may relate to treatment related changes. Continued follow-up is suggested to exclude progression of tumor.