40 years, Male, surveillance, day 56 of trial. Grade III anaplastic oligodendroglioma. Again seen are postsurgical changes of right frontal lobe tumor resection with interval increase in thick enhancement along the posterior aspect of the resection cavity compared to 11/2/2015. For example in the sagittal postcontrast images, the thickness of this area of enhancement measures 27 mm in the AP dimension, previously 20 mm. There is also corresponding increase in intermediate T2/FLAIR hyperintensity which on perfusion images demonstrates elevated cerebral blood volume. There is also mild increase in T2/FLAIR hyperintensity in the right frontal lobe extending inferiorly into the basal ganglia and right temporal stem. There is mild increase in mass effect with increased effacement of the right lateral ventricle midline shift from approximately 6 mm to 9 mm. CSF filled resection cavity in the right frontal lobe is again seen as well as a thin extra-axial collection beneath the craniotomy. Again seen are foci of intraparenchymal hemorrhage along the medial aspect of the resection cavity slightly increased since 11/2/2015. No uncal herniation. No hydrocephalus. Major flow-voids are preserved.
1. Postoperative changes of right frontal lobe tumor resection are again seen. Compared to MRI from 11/2/2015, there is interval increase in thick irregular enhancement along the posterior aspect of the resection cavity with corresponding increase in intermediate T2/FLAIR hyperintensity. Increased cerebral blood volumes are also demonstrated within this region. Although some of these findings may be treatment related, overall findings are suspicious for tumor progression and recommend continued close follow. 2. Compared to 11/2/2015, there is mildly increased vasogenic edema and mass effect including slightly increased midline shift from 6 mm to 9 mm.