Female 50 years old with Hx of multifocal GBM s/p reRT 3mo ago, on TMZ and Avastin Post-surgical changes of a right frontal craniotomy and tumor resection with associated ex vacuo of the right lateral ventricle. The resection cavity is multiseptated with areas of subtle enhancement along the posterosuperior aspect, some of which appears to be intra-axial, overall appearing stable in terms of enhancing pattern and configuration. An additional lenticular area of enhancement anteromedial and adjacent to the resection cavity just right of the falx appears unchanged from prior exam. No associated perfusion abnormality, edema or mass effect. Increased T2/FLAIR signal is noted along the resection margin as well as the left centrum semiovale, which appears stable from prior exams and likely represents gliotic changes.There is redemonstration of a non-enhancing T2/FLAIR hyperintensity within the right cerebellum, which causes mild effacement of the posterolateral aspect of the fourth ventricle, and measuring 12 x 18 mm (501/8), unchanged from prior exam.Subtle nodular enhancement of the right frontal horn, which abuts the anteromedial ependymal surface, is less conspicuous and measures up to 6 x 4 mm (1301/19), decreased from prior 13 x 9 mm accounting for technical differences.No evidence of restricted diffusion to suggest acute infarct. The ventricles and basal cisterns are patent. There is no midline shift or herniation. The major cerebral flow voids are intact.
1. Post-surgical changes of right frontal craniotomy with tumor resection. Mildly enhancing right frontal horn nodular lesion appears less conspicuous than prior exam. Subtle enhancement along the posterosuperior and anteromedial aspects of the resection bed appear stable from prior exam. No new lesions identified.2. Stable non-enhancing right paramedian cerebellar lesion.