History of GBM status post RT and TMZ. Left parieto-occipital craniotomy changes related to prior resection of tumor are redemonstrated. Overall, there is further contraction of the resection cavity. Multifocal peripherally enhancing left parieto-occipital lobe lesions are again seen as well as small enhancing nodules. A more inferolaterally located cystic ovoid component with peripheral enhancement demonstrates interval resolution of internal T1 signal, likely related to resolved blood products within the lesion. There appears to be overall decreased nodular enhancement involving the lesions, particularly involving the most inferior lesion. There is increased enhancement extending along the ependyma of the posterior horn of the left lateral ventricle (series 1403, image 81). There is overall slightly increased craniocaudal extent of T2/FLAIR signal as well as new signal extending along the splenium of the corpus callosum towards the midline. Perfusion images demonstrated slightly increased vascularity involving the largest component of the lesion. No new intra or extra-axial fluid collections are visualized. No midline shift is appreciated. There is no evidence for acute ischemia.
1. Multifocal left parietal occipital peripherally enhancing lesions overall demonstrate slight decreased central enhancement and nodularity with further contraction of the resection cavity.2. There is slight increased anterior extension of ependymal enhancement involving the posterior horn of the left lateral ventricle.3. Slight increased extent of FLAIR hyperintensity in the left cerebral white matter, which may be post-treatment related given relative hypoperfusion.3. Evolved blood products in small oval cystic cavity.