54 years, Male, anaplastic astrocytoma, on Avastin. This will be second MRI on Avastin. There is interval increase in masslike T2/FLAIR hyperintensity and enhancement involving the posterior body of the corpus callosum on the right and crossing to the left. There is also interval increase in masslike T2/FLAIR hyperintensity and enhancement involving the lateral aspect of the right thalamus. There is also mild increase in T2/FLAIR hyperintensity and enhancement in the right temporal lobe surrounding the right temporal horn extending into the right periatrial region. These findings are progressed compared to 5/20/2016 as well as 2/2/2016. These areas also demonstrate mild restricted diffusion.Remainder of the extensive patchy FLAIR signal abnormality involving the right greater than left cerebral hemispheres, centered in the right parietal lobe extending into the right temporal lobe with patchy areas of enhancement are not significantly changed. T2/FLAIR hyperintensity extending along the right corticospinal tracts is also not significantly changed. There is mild effacement of the right lateral ventricle which appears slightly worse in the interval. No significant midline shift. No uncal herniation. No hydrocephalus. Prior postsurgical changes including prior right-sided craniotomy are again seen. The right-sided mastoid air cells are opacified as before. Major flow-voids are preserved.
Findings suspicious for tumor progression in the setting of Avastin therapy with increased areas of masslike T2/FLAIR hyperintensity with enhancement including the right posterior body of the corpus callosum and crossing the midline, right lateral thalamus, as well as along the right temporal horn.