Clinical question: Evaluate for growth of a GBM. Patient had MRI on 3-24-15 during RT after seizure. Please compare MRI to prior imaging. Signs and symptoms: GBM. Pre- and post enhanced brain MRI:Examination demonstrates interval resolution of previously noted small right frontal subdural and small amount of epidural collection under a right large craniotomy flap.There is also interval decreased size and resolution of blood product within the surgical cavity since prior study.The remaining surgical cavity in the right superior temporal gyrus posteriorly demonstrate iso to hypointense T1 signal and mixed T2 signal intensity content. The cavity measures approximately 39 x 22 mm in transaxial dimensions. It demonstrate a thick irregular focus of enhancement posteriorly measuring approximately 28 x 18 mm in transaxial dimensions measured (post enhanced series 13 image 17) and highly suggestive of residual tumor. There is also an additional solid focus of enhancement along the superior aspect of the surgical cavity measuring at 20 x 20 mm (axial post enhanced series 13 image 14) which is also highly suggestive of tumor regrowth. There is also a small nodular focus of enhancement along the posterior medial aspect of surgical cavity measuring 8 x 8 mm in transaxial dimensions (axial post enhanced series 13 image 14) which is also concerning for residual/regrowth of tumor. A thin mildly irregular band of enhancement surrounds the rest of the surgical cavity. There is extensive surrounding FLAIR hyperintensity in the pattern of vasogenic edema however without significant mass effect and with resolution of previously noted deviation of midline to the left.There is no detectable additional foci of parenchymal or leptomeningeal enhancement.Interval resolution of leftward midline deviation and with stable normal size of the ventricular system.
1.Interval expected evolution of postoperative changes of right craniotomy with resolution of a small subdural and an epidural collection under craniotomy flap.2.Interval decreased size of right temporal surgical cavity and resolution of acute blood products within the surgical cavity.3.There are multiple solid loculated foci of enhancement along the posterior, superior and medial aspects of the surgical cavity wall all concerning for regrowth of tumor as detailed/measured above.4.Extensive FLAIR hyperintensity surrounding the surgical cavity with slight progression since prior exam however without evidence of significant mass effect and interval resolution of midline shift to the left.