Clinical question: L frontal GBM initial Dx 9/2012. s/p RT/TMZ+TMZ. Off all Tx.Signs and Symptoms: GBM.Comments: GBM Dx 9/2012. S/p RT/TMZ+TMZ. Please compare to earlier studies. | The patient is status post left frontal lobe surgery for removal of a left frontal lobe mass. Since the prior exam a new 18mm focus of Flair and T2 signal change has developed along the left fontal lobe at the anterior aspect of the left superior frontal gyrus at the inferior and anterior aspect of the surgical site. This now enhances heterogenously following contrast administration. This associated with increased relative CBV and dilated flow voids on SWI.Flair and T2 signal change adjacent to and inferior and posterior to the surgical site remains stable when compared to the previous exams.Punctate foci of susceptibility on the susceptibility weighted images are present in the subcortical white matter of the supratentorial brain along the frontal and parietal lobesNormal 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 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.
Since the prior exam a new focal lesion has developed at the anterior aspect of the right frontal lobe adjacent to the anterior and inferior margin of the surgical site which is suspicious for local recurrence.