Glioblastoma multiforme. Status post resection and sequential chemoradiation treatment. The patient developed recurrence which was re-resected in October 2015 followed by tumor vaccine (HSPPC96 vaccine trial). Recently started on Avastin. There are changes related to the previous resections of the left temporal glioblastoma. The extensive contrast enhancement in the adjacent left temporal parenchyma with extension along the posterior aspect of the internal and external capsules as well as the deep left parietal white-matter (reaching the lining of the left lateral ventricle) has significantly improved since the previous examination, in both intensity and extent. The associated extensive surrounding T2 hyperintensity is significantly improved with resolution of the midline shift and mass-effect on the left lateral ventricle. The more masslike, solidly contrast-enhancing nodule along the posterior resection margin has not changed and still measures up to 2.4 cm. It shows mild hyperperfusion on the relative cerebral blood volume color coded maps, unlike the remainder of the surrounding contrast enhancement, which is hypoperfused. There is no new postcontrast enhancement. There is no acute infarct. Mild, unchanged confluent T2-hyperintensity in the periventricular white-matter is nonspecific but may relate to previous treatment and chronic microvascular ischemia. There is mild ex vacuo enlargement of the left lateral ventricle. There is no gross orbital abnormality. Fluid signal in the left mastoid air cells has improved. There is new mucosal thickening and fluid in the right maxillary sinus, which in the proper clinical setting may reflect acute sinusitis. There is moderate mucosal thickening in the ethmoid sinuses.
1.Compared to previous examination from February 2016, there has been significant improvement of the extensive contrast enhancement surrounding the left temporal resection bed as well as the associated T2 signal and mass-effect as described above. This also remains hypoperfused and likely predominantly reflect post treatment change. The change is most probably the effect of Avastin.2.The more solid, contrast-enhancing nodule along the posterior left temporal resection margin remains unchanged and mildly hyperperfused and suspicious for recurrent tumor.3.Mucosal thickening and fluid in the right maxillary sinus may reflect acute sinusitis in the proper clinical setting.4.Improved left mastoiditis.