Brain tumor, follow-up. Again seen are postsurgical changes of right frontotemporal craniotomy for tumor resection. Again seen is masslike T2/flair hyperintensity in the right periatrial region extending across the corpus callosum into the left parietal lobe. T2/FLAIR hyperintensity involving the right basal ganglia and right frontal, temporal, and parietal white matter is not significantly changed. There are areas of thick enhancement along the medial aspect of the resection cavity, anterolateral to the resection cavity, as well as posteriorly abutting the tentorium compatible with treated tumor. There is mild apparent increase in enhancement involving the splenium and the left periatrial region on the post gadolinium spin echo sequence which is not seen on the SPGR and favored to be related to differences in contrast timing. There is also a new nodular enhancement in the right parietal white matter, axial post gad series 15 image 18 of 28.There is restricted diffusion within the tumor in the right periatrial region and splenium which was present previously but more prominent on the current study. No evidence of acute infarct. Unchanged additional areas of FLAIR hyperintensity in the bilateral periventricular and subcortical white matter which are nonspecific.No new mass-effect, midline shift, or uncal herniation. No hydrocephalus.
1. Compared to 11/26/2014, there is overall no significant change in extensive areas of masslike FLAIR hyperintensity and enhancement consistent with known high grade glial neoplasm. There is restricted diffusion involving the tumor within the periatrial region and splenium of the corpus callosum which was present on prior and compatible with Avastin effect. 2. Enhancement along the ventricular surface in the right periatrial region is again seen suspicious for subependymal tumor spread. 3. There is a new punctate focus of enhancement in the right parietal white matter which may represent treatment change and can be assessed on follow-up studies.