Clinical question: GBM. 2 wks post reRT+TMZ+bev. Signs and Symptoms: GBM. Pre and post enhanced brain MRI:Diffusion weighted images demonstrate interval increased restricted diffusion surrounding the right hemispheric surgical cavity since prior exam.There is however interval decreased right frontal vasogenic edema since prior exam anterior to the surgical cavity.There is also interval decreased size / thickness of enhancement surrounding the surgical cavity wall since prior study. For example the thick enhancing rim anterior to the surgical cavity on prior exam measured in the range of 30 to 36 mm compared to prior study measurements of between 19 to 21 mm. Enhancement along the inferior edge of the surgical cavity which measures approximately at 22 mm on prior exam has decreased to approximately 12 mm current study. The enhancement along the dorsal aspect of the surgical cavity which measures approximately at 25 x 35 mm has decreased in size and intensity of enhancement and measuring at approximately 18 to 21 mm.There is interval expansion of right lateral ventricle secondary to decreased mass effect from tumor and complete resolution of previously noted midline deviation to the left. Changes suggestive of ovarian degeneration on the right is again identified.Mild left hemispheric periventricular white matter informed hyperintensity similar to prior exam and likely representing post treatment/radiation change.
1.Overall there is interval improvement of patient's known right hemispheric tumor. There is interval decreased vasogenic edema, significant decreased in thickness of a large irregular rim of enhancement surrounding the surgical cavity as detailed/measured above. There is also decreased in intensity of enhancement since prior study.2.Interval decreased mass effect of right hemisphere with resultant re-expansion of the right lateral ventricle and resolution of leftward midline shift since prior study.3.There is however increased peri-surgical cavity restricted diffusion.