Clinical question: Progressive glioblastoma, compared to last MRI. Signs and symptoms: Post 2 cycles of PD L1 therapy. Pre- and post enhanced brain MRI:Examination demonstrates postsurgical and therapy changes of right anterior temporal and inferior frontal lobes without significant change since prior exam. A well demarcated surgical cavity with hemosiderin laden surgical wall and adjacent right temporal lobe as well as extensive surrounding FLAIR hyperintensity remains nearly identical to prior study.There is resultant ex vacuo dilatation of right lateral ventricle with slight rightward deviation of midline also similar to prior exam.On post enhanced images there is a tiny linear focus of enhancement along the medial aspect of surgical cavity and abutting the right frontal horn of lateral ventricle. There is no convincing evidence of any appreciable interval change in the size or extent of this focus of enhancement. It measures approximately 10 x 6 mm in transaxial dimensions similar to prior exam. Additionally mild enhancement of the ependymal lining of the right frontal horn and a small focus of parenchymal enhancement in the corpus callosum is noted. These findings also appears to be fairly similar to prior exam and without convincing evidence of change. Finding is more suggestive of posttreatment change however less likely possibility of tumor cannot be entirely excluded.
1.Post operative/treatment changes of right anterior temporal and right inferior frontal tumor without evidence of change since prior exam.2.Persistent stable right frontal periventricular and corpus callosum enhancement in size, morphology and extent since prior study and more suggestive of posttreatment related finding however less likely possibility of residual tumor cannot be entirely excluded..