GBM, on TMZ/Avastin. Evaluation for tumor progression. Again seen are postsurgical changes of right temporoparietal craniotomy for partial tumor resection involving the right temporal lobe. Please note some of the sequences on the current and prior studies are motion degraded; within this limitation, the nodular enhancement surrounding the right temporal resection cavity is not significantly changed. Again noted is enhancement extending along the right periatrial white matter towards the splenium which is stable to minimally decreased in the interval. Separate focus of enhancement involving the right temporal lobe cortex more anterolaterally is also stable to minimally decreased in the interval allowing for differences in technique. No new area of enhancement. Compared to most recent MRI dated 9/10/2015, there is no significant change in T2/FLAIR hyperintensity surrounding the resection cavity, particularly involving the right superior temporal and inferior frontal lobes. There is however interval increase in T2/FLAIR hyperintensity involving the right posterior frontal centrum semiovale and corona radiata without associated mass effect. When compared to 7/24/2015, there is bilaterally increased T2/FLAIR hyperintensity symmetrically in the periventricular region along the frontal horns and body of the lateral ventricles. Thicker T2/FLAIR hyperintensity surrounding the left occipital horn is not significantly changed in the interval. There is no significant change in size of the ventricular system which remains prominent.No evidence of acute infarct or acute hemorrhage. No new mass effect, midline shift, or herniation.
Compared to 9/10/2015, there is no convincing evidence of tumor progression. FLAIR hyperintensity and enhancement surrounding the right temporal resection cavity is similar to 9/10/2015 and decreased since 7/24/2015 related to Avastin therapy. Satellite lesion involving the right lateral temporal lobe is also not significantly changed. There is interval increased T2/FLAIR hyperintensity involving the right posterior frontal centrum semiovale and corona radiata compared to 9/10/2015. Compared to 7/24/2015, there is also increased T2/FLAIR hyperintensity bilaterally involving the periventricular white matter. These findings are favored to represent posttreatment change.