58 years, Female, evaluate GBM. On Avastin. Imaging was mildly degraded by motion. Stable postsurgical changes from right temporoparietal craniotomy with partial right temporal lobe tumor resection. There is minimal associated susceptibility, due to residual blood products. There is persistent nodular enhancement surrounding the right temporal lobe resection cavity. Anterior to the resection cavity, there is increased extent of T1 multinodular enhancement, measuring approximately 31 x 25 mm, previously 12 x 11 mm. There is increased right temporal FLAIR T2 hyperintensity. Perfusion imaging in this region demonstrates increased cerebral blood volume. A focus of restricted diffusion located on the margin of the right lateral ventricle occipital horn, measuring up to 1 cm, is unchanged. There are no new areas of restricted diffusion. No acute intracranial hemorrhage is identified. The ventricles are unchanged in size and configuration, with the lateral ventricles persistently mildly dilated. Major flow-voids are preserved.
Interval increase in nodular enhancement and FLAIR hyperintensity with areas of elevated cerebral blood volumes in the right anterior temporal lobe. Findings are suspicious for tumor progression. 