Malignant neoplasm of brain, as described. Evaluate for growth of GBM, s/p reRT/Avastin/TMZ. Pt had initial marked radiographic response on Tx.. Again seen are postoperative findings related to right frontoparietal craniotomy with heterogeneously enhancing mass with areas of restricted diffusion involving the right frontal lobe, insula, basal ganglia, and temporal and parietal lobes, with extension across the corpus callosum. The heterogeneous enhancement surrounding the treated cavity overall remains unchanged compared to previous exam, for example irregular enhancing component in the anterior aspect of the tumor measures 20 mm, previously 20 mm. There is significant interval improvement in the extent of enhancement compared to 7/10/2015, compatible with Avastin effect. There is extensive T2/FLAIR hyperintensity surrounding the surrounding the resection cavity in the temporal and frontoparietal region, extending to involve the splenium and along the right corticospinal tract which is unchanged. No new mass or new mass effect. There is no midline shift or herniation. The orbits and paranasal sinuses are grossly unremarkable. The skull and scalp soft tissues are unchanged.
No evidence of interval tumor progression, with no significant change in extent of FLAIR hyperintensity and enhancement surrounding the resection cavity compared to 9/9/2015. There is however significant decrease in the area of FLAIR hyperintensity and enhancement when compared to prior study from 7/10/2015 consistent with Avastin response.