66 years Male (DOB:3/9/1950)Reason: GBM. Pt om TMZ+TTF. History: GBM.PROVIDER/ATTENDING NAME: RIMAS V. LUKAS RIMAS V. LUKAS There is 78 by 42 mm mm sagittal dimension heterogenously enhancing mass centered in the deep white matter of the right frontal lobe and the adjacent subcortical white matter of the right parietal lobe . This previously measured similar sagittal dimensions. Cerebral blood volume map indicates that the enhancing component of the lesion within the right centrum semiovale is relatively high whereas other more peripheral components tends to be relatively lower.There is however a little more contrast enhancement within the right basal ganglia. Cerebral blood volume within this component appears to be very low. Contrast enhancement within the basal ganglia component of the lesion currently measures 18 x 17 mm and previously measured 13 x 16 mm. There is adjacentT2/FLAIR signal hyperintensity compatible with vasogenic edema in an area measuring 142 x 60 mm axial dimensions. This previously measured similar axial dimensions. There are satellite foci of enhancement in the adjacent brain. There is susceptibility effect within the mass. There is T2 signal hyperintensity present in the right midbrain and pons on the current exam which was also present on the prior exam. There are multiple microhemorrhages scattered throughout the lesion which were also present on the previous exam.There is associated mass effect with approximately 9 mm shift of the midline towards the left on the current exam which was approximately 9 mm on the prior exam. There is associated uncal herniation which was also previously present. There is also associated dilation of the left lateral ventricle associated with subfalcine herniation and there is a mild degree of transtentorial herniation also present.The patient is status post recent right sided craniotomy. There is an underlying extra-axial collection measuring up to 5mm thickness.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The distal right vertebral artery appears to be hypoplasticThe visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Since the prior exam the patient's right hemispheric mass consistent with glioblastoma has developed enlargement of the an enhancing component within the right basal ganglia. This component has low cerebral blood volume and is thus suspected to potentially represent radiation necrosis based on perfusion imaging. There is a component with high cerebral blood volume within the central portion of the lesion which based on the perfusion imaging would be more likely related to active neoplasm which has not enlarged since prior exam. 2.There is associated uncal, transtentorial and subfalcine herniation present.