Clinical question: Baseline exam prior to starting new systemic therapy; please assess extent of known metastatic disease and compare to scan from 5/5/2015. Signs and Symptoms: History of glioblastoma multiforme Pre- and post enhanced brain MRI:Negative diffusion weighted images.Examination redemonstrate extensive focus of FLAIR hyperintensity in the pattern of vasogenic edema however without significant mass effect in the right parietal-temporal and extending into the right frontal similar to prior exam in extent. A cavity forming ring enhancing mass consistent with patient's known GBM is again identified.This finding measures approximately at 34 mm in AP axis which is smaller compared to prior study measurement of 40 mm. Thick irregular rim enhancement of this lesion demonstrate no significant change. A previously measured focus of enhancement along the anterior superior aspect of the tumor measures at 14 x 10 mm (sagittal post enhanced series) compared to prior study measurement of 13 x 21 mm. Decreased size of cavity and enhancement suggestive of interval improvement.Ventricular system remains within normal size and with maintained midline.Small focus of linear enhancement in the right frontal lobe under a small right frontal craniotomy representing resection cavity demonstrate no significant change since prior exam.No evidence of new focus of signal abnormality or abnormal enhancement since prior study.
1.Slight interval decreased size of rim-enhancing necrotic lesion since prior exam as detailed/measured above.2.Extensive surrounding FLAIR hyperintensity with mild associated mass effect however without the radiation of midline remains stable. 3.Linear focus of enhancement in the right frontal lobe stable since prior exam.