Clinical question: Evaluate recurrent GBM. Compared to prior OSH imaging. Signs and symptoms: GBM. Pre- and post enhanced brain MRI:No evidence of restricted diffusion.Examination demonstrates a large focus of vasogenic edema in the left posterior temporal and with minimal extension into the left occipital lobe. Within this region there is a large enhancing mass measuring 29 x 25 x 23 mm in size. There is a internal focus of near CSF signal intensity suggestive of a small focus of surgical resection measuring approximately 16 x 7 mm in size (coronal T2 weighted series). The mass extends from the cortex across the left posterior temporal lobe and reaches the trigone of left lateral ventricle which is also mildly compressed secondary to the tumor. There is no detectable enhancement of the ependymal lining of the ventricle. Finding is consistent with patient's known glioblastoma.Constellation of findings results in subtle mass effect on the trigone of left lateral ventricle and without evidence of midline shift.Compared to prior examination there is significant interval increased size of tumor and surrounding vasogenic edema. On prior study the focus of enhancement measured approximately 14 x 12 mm in transaxial dimensions.The morphology as well as the signal intensity of brain parenchyma is otherwise within normal on all MRI sequences and without detectable additional foci of parenchymal enhancement.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.
1.Interval increased size of a left posterior temporal GBM and its surrounding vasogenic edema since prior study.2.The enhancing tumor measures at 29 x 25 mm on current exam compared to prior study measurement of 16 x 7.3.The tumor extends from the cortex across the left temporal lobe and reaches the trigone of left lateral ventricle without detectable enhancement of the ependymal lining.4.There is evidence of regional mass effect and without deviation of the midline.