Clinical question: Patient with GBM, status post surgery, RT and now on TMZ. Compared to outside institution MRI exam. Signs and symptoms: GBM. Pre and post enhanced brain MRI:Examination demonstrates post operative changes of a right posterior temporal-parietal craniotomy. A surgical cavity with CSF signal intensity in the right superior gyral of posterior temporal lobe measures at approximately 25 x 20 mm similar to prior exam. Extensive surrounding FLAIR hyperintensity without appreciable mass effect also remains nearly identical to prior exam. On post enhanced images there is a linear inhomogeneous enhancement along the posterior surgical cavity wall which considering the technique difference between the 2 exam (current study with thin slices compared to OSH exam of 6 mm slice thickness) demonstrate no convincing evidence of change. There is however a well-demarcated thick focus of enhancement along the anterior inferior aspect of the surgical cavity measuring at 4.5 mm in thickness and 6 mm at the base along the cavity wall which is highly concerning for focus of recurrence or residual tumor. This finding is barely detected on prior exam on post enhanced series 11 image 11. Unremarkable exam otherwise for patient's stated age of 73 and without evidence of any new findings.
1.A focus of enhancement in the right posterior temporal surgical cavity wall (anterior- inferior) concerning for residual or recurrence tumor, measuring 6 x 4.5 mm with significant interval increase since prior study.2.Postoperative changes of tumor removal in the right posterior temporal with stable thin however irregular band of enhancement along the posterior surgical cavity wall which could represent postsurgical change or residual tumor. Further follow-up is needed for further assessment.