62 years, Male, GBM, 4 week post RT. Again seen are postsurgical changes related to biopsy of paramedian right frontal lobe mass which measures approximately 3.5 x 2.3 cm in the AP and transverse dimensions, previously 2.9 x 1.7 cm, measured similarly in the axial plane. In particular, there has been significant increase in masslike nodular thickening involving the right lateral aspect of the lesion. More medial necrotic component is slightly increased in size as well, and there appears to be more necrosis involving the previously more solid component medially. Lesion again extends to the dural surface and associated with mild adjacent leptomeningeal enhancement which was seen previously and suspicious for leptomeningeal involvement. There is surrounding T2/FLAIR hyperintensity in the adjacent right posterior frontal lobe which is significantly increased since prior studies. There is no midline shift or herniation. Blood products within the lesion are similar to prior. No new lesions elsewhere in the brain are appreciated. There is increased linear enhancement along the biopsy tract compatible with evolution. Ventricles remain stable in size without evidence of hydrocephalus.
1. Mild interval increase in size of right paramedian frontal lobe lesion related to known high-grade glioma. There is more pronounced increase in surrounding FLAIR hyperintensity, much of which which likely represents vasogenic edema. Given history of recent radiation these findings may represent superimposed post treatment change but recommend continued close follow-up. 2. Adjacent leptomeningeal enhancement is again seen and was present pretreatment and suspicious for leptomeningeal spread.