Male, 61 years old, with newly diagnosed GBM status post biopsy. Postoperative MRI for radiotherapy treatment planning. Post biopsy changes are seen at the site of the right posterior frontal paramedian enhancing lesion. On comparison with the prior examination the lesion shows continued interval increase in size now measuring up to 27 x 18 mm, previously 20 x 15 mm. An increased quantity of central nonenhancing tissue may reflect further internal necrosis and/or blood product. Several of the paramedian sulci just posterior to the lesion demonstrate enhancement which is concerning for leptomeningeal spread of tumor.No other concerning enhancing lesions are seen. Minimal enhancement along the right frontal biopsy tract likely represents granulation tissue. A developmental venous anomaly is evident in the right cerebellum. The right sided dura is mildly but diffusely thickened and there is a thin layer of low T1-signal subdural fluid on the right with susceptibility effect likely representing old subdural blood product.
Interval increase in the size of an enhancing right posterior superior frontal mass status post biopsy.