Clinical question: Evaluate exam after 8 weeks of systemic therapy. Compared to prior baseline exam from 3 -- 17 -- 15. Signs and symptoms: Patient with history of glioblastoma multiform. Pre-and post-enhanced brain MRI:No diffusion weighted abnormalities.Examination redemonstrates a very large irregular, enhancing and centrally necrotic tumor in the left temporal lobe with interval increased size since prior study. A very irregular shape of tumor makes precise measurements difficult however within this limitation are measurements in variation of undulation stem mostly increased size of tumor. Similar to prior study the posterior medial aspect of tumor is inseparable from the trigone and the occipital horn of left lateral ventricle which is involved with the tumor and demonstrate enhancement along the ependymal lining of the ventricle. Extensive surrounding vasogenic edema involving the entire left temporal lobe and extending into the left occipital and left basal ganglia demonstrate no convincing evidence of change. The overall mass effect of this tumor results in deviation of midline to the right of approximate the 6-mm at the level of third ventricle which has a slightly progressed since prior exam. Mild prominence of the right lateral ventricle demonstrates subtle interval progression as well. The basal cistern remains patent.There is no remote new foci of flair hyperintensity or enhancement since prior exam.
1.Interval increased size and extent of left temporal lobe glioblastoma as detailed.2.Slight interval increased mass effect and resultant 6-mm rightward midline shift at the level of third ventricle.3.Slight interval increased size of right lateral ventricle since prior exam without evidence of hydrocephalus.