High-grade glioma status post craniotomy, chemotherapy, radiation therapy. Treated with Avastin. Please note that a dedicated brain tumor protocol was inadvertently not obtained. Therefore, perfusion imaging was also not performed.There are numerous new foci of susceptibility along the left frontal centrum semiovale, with other stable scattered foci elsewhere in the brain both supratentorially and infratentorially, noted previously and likely posttreatment related.There is redemonstration of postoperative changes along the left parietal operculum. Minimal associated curvilinear intrinsic T1 hyperintensity with areas of hemosiderin staining remain. The extent of surrounding abnormal T2 hyperintensity appears similar even dating back to 9/19/2014.There is additional treated recurrent tumor in the left frontal lobe, with mild encephalomalacia anteriorly. There is been significant interval increased extent of abnormal T2/FLAIR hyperintensity throughout the frontal deep white matter with extension into the body of the corpus callosum which now appears thickened, previously measuring 5 mm and now measuring 8 mm. The previous signal in the genu of the corpus callosum is not as well appreciated on the current exam. The previously noted somewhat ill-defined area of subcortical T2 hyperintensity along the left superior frontal gyrus is now more conspicuous on 10/26.Other patchy areas of abnormal FLAIR hyperintensity in the deep and subcortical white matter, left greater than right side appear stable. No new enhancing lesions are seen. There is no midline shift or mass effect. Ventricular system is stable, including left ventricular atrial ex vacuo dilatation. There is a right maxillary sinus mucosal retention cyst.
1.Progression of nonenhancing FLAIR hyperintensity of the previously seen left paramedian superior frontal gyrus subcortical white matter with now confluent involvement of bilateral centrum semiovale in the frontal lobes extending into the significantly thickened body of the corpus callosum. Findings are nonspecific but are most concerning for continued disease progression. Patient may be recalled for additional MR perfusion imaging at no additional cost, for further evaluation as clinically indicated. Associated posttreatment/inflammatory changes are also possible.2.New foci of punctate susceptibility along the left body of the corpus callosum, which may be posttreatment related or represent petechial hemorrhage relating to underlying neoplasm.3.Stable treated disease in the left parietal operculum and left anterior frontal lobe.