Male, 63 years old, with history of glioblastoma multiforme, currently on clinical trial with Temodar and investigational agent. Left cranial postoperative findings are redemonstrated. A 7 mm epidural collection subjacent to the craniotomy flap has not significantly changed from prior.A left temporal lobe resection cavity is similar in size and shape. Fluid in the cavity demonstrates an interval reduction in FLAIR hyperintensity suggesting resolution of proteinaceous contents.Since the prior examination, enhancing tissue with corresponding elevated rCBV within the anterior left temporal lobe has decreased in thickness. Associated edema and FLAIR hyperintensity in the surrounding tissue is also mildly improved.The above mentioned enhancing tissue is, however, contiguous with a growing nodule of enhancement along the anterior margin of the resection cavity which also demonstrates mild elevated rCBV. This tissue measures up to 20 x 16 mm, previously 11 x 4 mm. Ill-defined infiltrative enhancement extends posteriorly from this dominant nodule along the medial aspect of the cavity to the level of the left atrial margin, and these areas of enhancement also seem slightly more conspicuous.Generalized ill-defined periventricular white matter T2 hyperintensity is again seen similar to the prior examination. Ex vacuo dilatation of the left lateral ventricle is unchanged. The size and shape of the ventricular system is stable. Hypoplasia of the right cerebellum is also redemonstrated.
A mixed pattern of disease response is seen. For example, enhancing tissue within the anterior left temporal lobe has decreased in thickness with a corresponding decrease in associated parenchymal edema. However, more posteriorly, along the margin of the left temporal resection cavity, a nodule of enhancing tissue with mild corresponding rCBV elevation has substantially increased in size.Partial resolution of inflammation within the left temporal lobe is suspected given partial clearing of the fluid within the resection cavity.