 There is redemonstration of right frontoparietal craniotomy. There is significant interval increase in extent of T2/FLAIR hyperintensity in the right cerebral hemisphere related to vasogenic edema compared to 7/30/2015. There is minimal leftward midline shift of 3 mm at the level of the lateral ventricles (401/24) that was not seen in the previous study. There is effacement of the right lateral ventricle Restricted diffusion is seen in the right frontal lobe which is more pronounced and increased in size. There is irregular nodular rim enhancement surrounding the resection site which has increased since the previous study of 7/30/2015. The lesion measures 37 mm in its craniocaudal extent (1701/22) compared to 27 mm in the previous study.Susceptibility images demonstrates blood products within the lesion similar to prior. No uncal herniation. No hydrocephalus.Perfusion images were obtained and processed on a separate workstation but could not be transferred to local PACS. There are areas of elevated CBV associated with the enhancement surrounding the resection cavity raising suspicion for tumor. There is also mild associated restricted diffusion.
1. In comparison to the previous study there is significant increase in the vasogenic edema of the right frontal and parietal lobes with increased mass effect including minimal leftward midline shift and downward partial effacement of the right lateral ventricle. There is also marked increase in enhancement surrounding the resection cavity with mild restricted diffusion and elevated cerebral blood volumes. Although patient has had recent radiation and posttreatment change is in the differential, early tumor recurrence remains a strong possibility. 2. Minor contrast extravasation as described in the technique section.