Male 51 years old with GBM, multiple recurrences, now on CCNU+Avastin+TTF Post-surgical changes of a right frontal craniotomy and partial tumor resection with stable overlying dural thickening/enhancement. There is a slight decrease in enhancement associated with the right frontal mass (12/49), although there appears to be an increased rind of enhancing soft tissue thickening along the lateral aspect of the lesion. The mass measures approximately 28 x 38 mm, not significantly changed from prior 27 x 42 mm. A small nodular focus of enhancement posteromedially appears slightly decreased from prior exam. Again seen is intrinsic T1 hyperintensity along the medial aspect of the resection cavity. Post-surgical changes of a right temporo-parietal craniotomy and partial tumor resection with stable overlying dural thickening/enhancement. A right temporal lobe lesion (12/67) measures approximately 20 x 20 mm, decreased in size from prior 28 x 30 mm. The lesion has a thin discontinuous rim of enhancement, markedly deceased from prior exam. The mass demonstrates mild restricted diffusion possible secondary to Avastin effect. Surrounding FLAIR signal abnormality appears improved in between the lesions. The previously described area of tram-trak enhancement in between the lesions also appears improved from prior exam. No new areas of enhancement identified.T2 hyperintensity within the left frontal and parietal lobes without associated enhancement appears similar to prior exam.The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1. Post-surgical changes of a right frontal and temporo-parietal craniotomy with partial tumor resection. The right frontal and temporal lesions appear overall improved from prior exam compatible with Avastin effect. There is however slight increase in masslike signal abnormality with enhancement along the lateral aspect of the right frontal lesion which is suspicious.2. T2 hyperintensity within the left frontal and parietal lobes suggestive of non-enhancing tumor again seen and appear stable from prior exam.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.