Clinical question: h/o GBM currently on trial with MRI changes concerning for progression. Signs and Symptoms: preop planning for biopsy Pre- and post enhanced brain MRI:Examination is performed utilizing Stealth protocol and is not a true diagnostic exam.Examination redemonstrates a large infiltrative type enhancing tumor in the right anterior frontal lobe extending from vertex inferiorly to the corpus callosum and inseparable from the right lateral ventricle. There is no significant change since prior exam from 6-24-15 considering difference in current surgical planning study and prior diagnostic brain MRI.Similar in signal intensity and with similar pattern of enhancement there is an adjacent high convexity right frontal mass immediately posterior to the larger lesion is again noted. This finding on axial post enhanced image 158 of series 5 measures at 27 x 26 mm which is larger than prior study measurement of approximately 20 x 20 mm. There is extensive surrounding vasogenic edema with resultant effacement of adjacent cortical sulci, significant mass effect on the right lateral ventricle and leftward radiation of midline of approximately 11 mm with interval progression since prior study measurement of 8 mm.
Large infiltrating necrotic loculated mass in the right anterior and mid frontal lobe with significant surrounding vasogenic edema and resultant 10 mm midline shift to the left as detailed.