Female, 76 years old, with GBM, status post RT. A large heterogeneous tumor is redemonstrated occupying the left parietal lobe, left posterior medial temporal lobe and splenium of corpus callosum with extension across midline. Sequelae of prior left parietal approach biopsy are again seen with reduced procedure related enhancement at the burr hole site.Since the prior examination, the heterogeneous, predominantly rim-enhancing lesion has mildly increased in size with measurements increased on the order of 2 to 3 mm depending on where the measurements are made. Much of this mild interval increase in size seems to be due to the development of more and larger internal cystic or necrotic spaces. The entire lesion is associated with strong susceptibility artifact and some of the cystic spaces contain subacute blood product which likely accounts for scattered areas of restricted diffusion. A modest degree of T2 hyperintensity is present within the parenchyma surrounding the lesion and this is slightly increased from the prior exam. The T2 signal now extends into the left occipital lobe, to the left paracentral lobule superiorly, and along the left medial temporal lobe structures. Minimal progressive T2 signal is also seen along the right ventricular atrium. There is moderate regional mass effect with sulcal effacement and effacement of the left ventricular atrium. There is a very slight herniation of the posterior medial left temporal lobe across the tentorial incisure.The ventricular system appears similar to the prior examination in terms of caliber and morphology including areas of tumor related mass effect. Scattered small foci of T2 hyperintensity are evident within the cerebral hemispheres showing no significant change from the prior exam.
Redemonstrated is a large heterogeneously enhancing tumor centered on the left parietal lobe with extension across the splenium of the corpus callosum to the right cerebral hemisphere.Since the prior examination, the tumor shows progressive internal cystic and/or hemorrhagic degeneration. The overall size of the lesion has increased by 2 to 3 mm, and the degree of surrounding T2 hyperintensity has also mildly expanded.Given the recent completion of radiotherapy and the relatively modest degree of lesion expansion, it would be reasonable to entertain the possibility that these changes are treatment related. Continued follow-up will be necessary to exclude the possibility of progressive disease.