Glioblastoma. Status post resection on January 28, 2016. Initially presented with right to astrocytoma in 2012. Resected twice and treated with radiation treatment. On last partial resection in 2016, pathology revealed glioblastoma. The previous examination from the outside institution is a functional MRI and does not provide adequate anatomic detail to allow adequate comparison.There are changes from the previous left frontal craniotomy and partial tumor resection. A small surgical cavity, measuring up to 2.1 cm, is present in the anterior-medial aspect of the left frontal lobe. Deep to the cavity, there is extensive heterogeneous contrast enhancement in the left frontal parenchyma, which measures 6.9 cm x 5.0 cm axially and 4.9 cm craniocaudally. The contrast enhancement extends posteriorly along the external capsule and there are adjacent small ring-enhancing lesions in the left basal ganglia next to the posterior limb of the internal capsule. The contrast enhancement also extends along the frontal horn of the left lateral ventricle as well as the genu of the corpus callosum. The contrast enhancement is associated with extensive surrounding infiltrative FLAIR hyperintensity (related to tumor and vasogenic edema) and causes mass-effect on adjacent structures, with associated subfalcine and uncal herniations. The infiltrative signal also extends into the right frontal lobe. There are numerous foci of susceptibility artifact in the left frontal lobe likely represent microhemorrhages and posttreatment change. There is no acute infarct, accounting for the hemorrhage.On dynamic susceptibility-weighted, contrast-enhanced MR perfusion imaging, there is elevated cerebral blood volume correlating with the contrast enhancement in the left frontal lobe.A multiloculated cystic lesion involving the anterior left temporal lobe may reflect focal encephalomalacia from a more remote surgery. This shows contrast enhancement only on its anteromedial border which may represent an extension from the large contrast enhancement in the left frontal lobe. Dural enhancement underlying the left craniotomy flap is expected postoperative change. There is no destructive skull lesion. There is trace mucosal thickening in the paranasal sinuses.
1.Extensive areas of heterogeneous contrast enhancement in the left frontal lobe with associated elevated cerebral blood volume are suspected to represent extensive residual glioblastoma. It is associated with extensive infiltrative FLAIR hyperintensity (related to tumor and vasogenic edema) and associated mass-effect causing subfalcine and uncal herniations. Tumor also involves the genu of the corpus callosum, and the enhancement extends to the subependymal surface of the frontal horn of the left lateral ventricle.2.Resection cavity in the anterior left temporal lobe reflects the more remote surgery. The contrast enhancement extends from the left frontal lobe towards this temporal surgical cavity.