Reason: Glioblastoma sp/Clinical Investigation History: GBM Exam is somewhat motion limited. There is been interval expected evolution of previously seen postoperative changes relating to left parietal occipital craniotomy for resection of underlying mass, with decreased hemosiderin along the left occipital surgical tract. Overall, the rind of nodular enhancement surrounding the irregular resection cavity has increased in thickness. Perfusion imaging does demonstrate prominence of elevated are CVP especially along the medial margin of the area of peripheral enhancement. There is similar extent of ependymal enhancement along the left occipital horn.The vasogenic pattern of T2/FLAIR hyperintensity within the left temporal and occipital lobe white matter has slightly further progressed, with increased medial extension along the splenium of the corpus callosum as well as in the left paramedian posterior parietal subcortical white matter (401/18-19). There is mild dural enhancement and thickening underlying the craniotomy flap, likely postoperative. Enhancement along the surgical tract extending to the bone is slightly more conspicuous.A subtle subcortical enhancing curvilinear structure is again seen in the right temporal lobe, likely a developmental venous anomaly. There is effacement of the occipital horn of the left lateral ventricle, similar to prior. There is no midline shift. The basal cisterns are maintained. The major cerebral flow voids are intact.Incidental note is made of a small area of enhancement along the left lateral frontal scalp which now extends to the skin surface, previously more ring-enhancing appearance. This resides in the left temporalis muscle, and correlation with physical exam is recommended as this may correlate with previous site of stereotactic frame attachment.
1.Interval expected evolution of postoperative changes related to recent left parieto-occipital tumor recent reexcision. Interval increased thickness of peripheral heterogeneous and nodular rind of enhancement, with hyperperfusion suggested along the medial margin, concerning for tumor progression.2.No significant interval change in left occipital ependymal enhancement. 3.Slight medial progression of vasogenic pattern of nonenhancing nonspecific T2/FLAIR hyperintensity within the left posterior cerebral white matter, which remains nonspecific.