Female, 68 years old, with glioblastoma multiforme status post RT and temazolamide. Evidence is seen of prior resection or partial resection of a tumor involving the left inferior and middle frontal gyri. Since the prior examination, irregularly marginated, nodular enhancement deep to the resection site has increased in size. These areas of enhancement do correlate with elevated rCBV. The degree of associated T2 hyperintensity surrounding this lesion along with local mass effect has also increased from prior.No additional areas of pathologic intracranial enhancement are suspected. Ill-defined FLAIR hyperintensity just below the lesion within the left basal ganglia is unchanged. Likewise, ill-defined bilateral periatrial T2 hyperintensity, and scattered discrete foci of cerebral white matter T2 hyperintensity, are unchanged including when compared to the preoperative examination. No intracranial hemorrhage is suspected. The ventricles and sulci are slightly more prominent than on prior examination suggesting underlying mild parenchymal volume loss.
Since the prior examination, there has been an increase in the size of irregularly marginated enhancement within the left frontal lobe tumor bed. The degree of surrounding T2 hyperintense signal and edema has also increased. The enhancing tissue corresponds to elevated rCBV which favors true tumor progression. Pseudoprogression is considered a less likely diagnosis.