Male, 34 years old, with recurrent glioblastoma, eight week follow-up post-trial. Again seen is evidence of left frontal lobe resection for recurrent glioblastoma. The resection cavity contains fluid which is still FLAIR hyperintense but less T1 hyperintense suggesting resolving proteinaceous or hemorrhagic products. The cavity is not significantly changed in size and morphology.The geographic extent of T2 signal abnormality surrounding the resection cavity has increased mildly from the prior examination. However, a thick and somewhat nodular rim of enhancement particularly along the inferior resection cavity margin is redemonstrated appearing thicker and more conspicuous than on the prior examinations. rCBV mapping is equivocal as it shows areas of increased and of decreased blood volume within this enhancing tissue. No entirely new areas of pathologic enhancement or signal abnormality are seen. Bilateral periventricular T2 hyperintensity is unchanged and may be related to prior therapy. No significant generalized mass effect is detected. The ventricular system is stable in size and morphology.
Since the prior examination, enhancing tissue along the inferior margin of the left frontal resection cavity has increased in thickness and conspicuity. The differential would include progressive disease as well as a treatment-related effect. rCBV mapping in this case does not provide any reliable guidance. No other concerning changes are seen elsewhere in the brain.