 MRI brain: There are postoperative findings related to prior left occipital lobe GBM resection. There has been interval evolution of the resection cavity and postoperative blood products. There is dural enhancement related to postsurgical changes, unchanged. Since the prior exam dated 3/4/2016, there has been marked interval increase in the irregular heterogeneous enhancement surrounding the resection cavity in the occipital lobe extending to the posterior parietal lobe. There is linear enhancement which extends to the ependymal lining of the left occipital horn, as seen on prior exam. There is unchanged mass effect on the left lateral ventricle. There are additional areas of more nodular enhancement seen superiorly to the resection cavity, which appears slightly more prominent compared to prior. There has been increase in the extent of T2/FLAIR hyperintensity in the left occipital lobe extending to the temporal lobe. There is no evidence of acute ischemia. No hydrocephalus. No midline shift or herniation. Incidental note is made of normal variation of slight medial extension of a portion of the right occipital lobe likely through a small tentorial defect. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniovertebral junction are within normal limits. There is mild mucosal thickening in the right maxillary sinus.MRA brain:The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. Bilateral posterior communicating arteries are present. The right vertebral artery is dominant. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.MRA neck: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber, without evidence of stenosis or occlusion. Both vertebral artery origins are patent. There is no evidence of stenosis or occlusion.
1. No evidence of acute ischemia. Since prior postoperative study from 3/4/2016, there has been significant increase in heterogeneous enhancement surrounding the left occipital resection cavity highly suspicious for progression of known high-grade glial neoplasm. There is also increase in surrounding edema. No midline shift or herniation.2. No significant stenosis in the intracranial circulation or the extracranial circulation in the neck.