Glioblastoma. Status post surgery followed by concomitant chemoradiation treatment and subsequent adjuvant chemotherapy. Now off treatment. There are postoperative changes from previous left parietotemporal tumor resection. The irregular contrast enhancement in the treatment bed is largely similar to prior allowing for slight differences in technique/reduced contrast dose. There is however contrast enhancement along the lining of the occipital horn of the left lateral ventricle which is minimally increased compared to the two previous examinations. The extensive T2-hyperintensity involving a significant part of the left cerebral hemisphere remains unchanged as well as the more widespread, nonspecific scattered foci of T2 FLAIR hyperintensity in the periventricular white matter. Numerous foci of susceptibility in the treatment bed related to chronic blood products remains unchanged. There is unchanged mild mass-effect surrounding the treatment bed while the remainder of the brain shows moderate brain volume loss. There is no new mass effect or new foci of abnormal enhancement aside from the left occipital horn. The presence of susceptibility effect in the treatment bed limits the value of the dynamic MR perfusion study.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is a partially empty sella. The orbits are grossly unremarkable.
Posttreatment changes with irregular enhancement in the left parietal and temporal lobes is largely similar to prior study. There is however mild interval increase in enhancement along the ependymal surface of the left occipital horn compared to 1/28/2016 and 11/25/2015 which is suspicious for subtle tumor progression. Suggest close attention on follow-up. No abnormal enhancement involving the ventricular wall remote from this region or abnormal leptomeningeal enhancement to suggest CSF dissemination. Extent of FLAIR signal abnormality is not significant changed.