Reason: temporal lobe lesion History: temporal lobe lesion. GBM Please note the postcontrast images are moderately limited due to patient motion.There are postsurgical findings of right temporal craniotomy for resection of a right temporal lobe GBM. The resection cavity has decreased in size measuring 2.5 x 1.8 cm, previously 3.6 x 3.3 cm, with evolution of blood products seen on the prior exam. Susceptibility surrounding the resection cavity is likely due to prior blood products. There is significant surrounding T2/FLAIR hyperintense signal, which is increased in extent in all directions and is more confluent. Mild right to left midline shift is unchanged measuring 7 mm. There is a significantly increased thickened rind of irregular enhancement surrounding the resection cavity and extending into the adjacent parenchyma. Mild restricted diffusion is present along the margins of the resection cavity, which has become more diffuse since the prior exam. Perfusion imaging in this region shows increased rCBV in the enhancing regions, which is decreased in the surrounding areas of white matter abnormality.An enhancing satellite lesion in the right temporal lobe has increased in size with increased posterior extension measuring 2.1 x 0.8 cm, previously 1.2 x 0.7 cm, now extending to directly abut the enhancing portion of the resection cavity. There may be minimal hyperperfusion in this region.There is mass effect on the right lateral ventricle. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is opacification of the right mastoid air cells and inner ear.
1.Enhancement, diffusion restriction and hyperperfusion surrounding the resection cavity is suspicious for recurrent/residual tumor.2.Enhancing more inferior right temporal lobe satellite lesion has increased in size and is now contiguous with the enhancing portions of the resection cavity.3.White matter abnormality has increased in extent since the prior exam.4.Opacification of the right mastoid air cells and inner ear, nonspecific.