50-year-old female with glioblastoma on radiation therapy, evaluate for change in tumor size while on treatment area patient is experiencing headaches. There has been interval decrease in size of the patient's enhancing right posterior frontal lobe mass, measuring 34 mm transverse x 30 mm AP (previously 35 mm transverse x 38 mm AP. Additionally, there is significantly less vasogenic edema and its related mass effect, with right to left midline shift now measuring 4 mm (previously 7 mm). Beyond the vasogenic edema, there has been an increase in the degree of T2 abnormality involving the anteromedial frontal lobe, now crossing the splenium, and extending into the adjacent left frontal lobe. As before, there is persistent T2 abnormality with gyral thickening involving the anterior right temporal lobe and insula. There are small, patchy foci of new enhancement associated with both the T2 abnormality crossing the corpus callosum as well as within the right peri-insular frontal gyri. Perfusion analysis demonstrates elevated corrected rCBV within the enhancing rim of the primary lesion, especially along its undersurface. There is a suggestion of subtly increased rCBV involving the involved right hemispheric white matter (including the rightward corpus callosum) as compared to the contralateral side.There is no evidence of acute intracranial hemorrhage or acute infarct. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. Redemonstrated is a right maxillary sinus retention cyst. Remaining paranasal sinuses and mastoid air cells are clear. Expected vascular flow-voids are demonstrated.
1.Decreased size of a right posterior frontal lobe high-grade astrocytic neoplasm with concurrent decrease of associated vasogenic edema as well as mass effect.2.There has been an increase in the degree of T2 abnormality involving the anteromedial frontal lobe, now crossing the splenium, and extending into the adjacent left frontal lobe. 3.As before, there is persistent T2 abnormality with gyral thickening involving the anterior right temporal lobe and insula.4.There are small, patchy foci of new enhancement associated with both the T2 abnormality crossing the corpus callosum as well as within the right peri-insular frontal gyri. 5.Perfusion analysis demonstrates elevated corrected rCBV within the enhancing rim of the primary lesion, especially along its undersurface, evidence for viable tumor. There is also a suggestion of subtly increased rCBV involving the involved right hemispheric white matter (including the rightward corpus callosum) as compared to the contralateral side.