78 yo F with GBM s/p STR, evaluate for extent of disease for RT planning History: post-resection imaging There has been evolution of recent postoperative changes of right frontal craniotomy for near-total tumor resection. Lobulated enhancing tissue along the posterior/deep aspect of the resection cavity along the callosal genu and hypothalamus likely reflects residual tumor and appears slightly larger in the interval. There is more conspicuous interval increase in enhancement along the medial aspect of the resection cavity including the left paramedian frontal lobe as well as the right anterior inferior aspect of the basal ganglia, areas which demonstrated restricted diffusion on prior MRI related to postoperative ischemic injury. There is also increased volume loss in the left paramedian frontal lobe. Extent of T2 FLAIR hyperintensity representing vasogenic edema in the right frontal lobe is markedly improved.There is no midline shift or herniation. No hydrocephalus.
Evolution of postsurgical changes related to near total tumor right frontal glioblastoma resection. Masslike enhancement along the deep, posterior aspect of the resection cavity likely reflects residual tumor and has mildly increased in size in the interval. Interval increase in enhancement involving the left paramedian frontal lobe and right anterior inferior basal ganglia is favored to represent evolution of postoperative ischemic injury.