 There are postsurgical findings related to right-sided craniotomy and tumor resection with cavities in the right anterior temporal lobe and the inferior right frontal lobe. There is evidence of prior stereotactic biopsy in this region as well. Since the prior examination from 8/25/2016, there has been an increase in the confluent T2 hyperintensity in the anterior right frontal lobe and extending along the anterior genu of the corpus callosum, further into the left frontal lobe. There is an associated increase in marginal enhancement in the right anterior frontal portion and there is extensive confluent restricted diffusion in this region. These areas do not demonstrate increased cerebral blood volume, which may be related to Avastin therapy. There is also a slight increase in T2 intensity posterior to the resection cavity. There is unchanged mild midline shift to the right and mild ex vacuo dilatation of the right lateral ventricle due to volume loss. There is redemonstration of susceptibility in the right frontal region and multiple additional foci of susceptibility consistent with blood products surrounding the resection cavity. The brainstem and cerebellum are intact. The orbits are unremarkable.
Compared to examinations on 8/25/2016 and 4/7/2016, increase in T2 signal abnormality, enlargement of the area of restricted diffusion, and enhancement of the lesion centered in the right anterior and inferior frontal lobe are suspicious for tumor progression, although at least some of the findings, such as "persistent diffusion-restricted lesions" may be attributable to superimposed effects of Avastin therapy. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.