Clinical question: Evaluate for growth of GBM. Patient on PD L1 abnormality immunotherapy trial. First MRI on treatment. Signs and symptoms: Evaluate GBM. Pre and post enhanced brain MRI:Examination demonstrates significant interval increased vasogenic edema surrounding an interval increased enhancing left posterior temporal necrotic GBM.The enhancing necrotic tumor measures at least at 44 x 41x 38 mm in transaxial dimensions compared to prior study remeasurement of 27 x 25 x 23 mm. Thick tumor extensively encases the left occipital horn of lateral ventricle and reaches the trigone the surrounding vasogenic edema that was localized around the tumor now extends anteriorly to nearly the tip of the left temporal lobe and into the left basal ganglia/thalamus and posteriorly extending to left occipital lobe. Findings results in increased intracranial pressure and weightRightward deviation of midline of approximately 14 mm. There is also mild increased size of left lateral ventricle since prior study which measures approximately 16 mm in largest transverse axis compared to prior study measurement of 13.5 mm.All the CSF spaces remain widely patent. Stable postoperative changes of left posterior temporal craniotomy.No detectable new foci of parenchymal abnormal signal intensity or ecchymosis/leptomeningeal abnormal enhancement.Unremarkable images through the orbits, calvarium, paranasal sinuses and mastoid air cells.
1.Interval increased size of a necrotic enhancing left posterior temporal GBM and its surrounding vasogenic edema with resultant new rightward deviation of midline as detailed/measured above. Tumor currently measures at 44 x 41 x 38 mm compared to prior study measurement of 27 x 25 x 23mm.2.Mild interval increased size of left lateral ventricle since prior exam is also noted.