Male, 37 years old, with recurrent glioblastoma. Review of prior examinations demonstrates evidence of multiple prior resections in the right posterior parietal lobe. A resection cavity remains evident in this area extending from the surface of the brain inferiorly and anteriorly to the level of the right ventricular atrium. The margins of the cavity are densely hemosiderin stained, and the cavity itself is grossly similar in size to the prior exam.Since the prior examination, however, diffuse T2 hyperintensity surrounding cavity and extending into the adjacent parenchyma has increased. Signal abnormality now involves nearly the entire right parietal lobe, parts of the right occipital lobe, and parts of the right temporal lobe. This abnormal tissue also contains a dense collection of foci of susceptibility likely representing blood product. Matching the pattern of new T2 signal abnormality, there has also been an increase in the quantity and extent of thick, ill-defined pathologic enhancement. Of note, this process now crosses midline via the splenium of corpus callosum which is progressively thickened. Where the presence of susceptibility does not obscure assessment, areas of progressive enhancement are also associated with elevated rCBV.Mild regional mass effect is seen in the areas of progressive abnormality. Mild periventricular T2 hyperintensity in the left hemisphere is nonspecific but may be related to prior therapy, as are numerous scattered foci of susceptibility through the cerebral hemispheres. The ventricle system is stable apart from very mild progressive effacement of the right lateral ventricle.
Findings compatible with progressive tumor. Abnormal signal and/or pathologic enhancement now occupies a majority of the right parietal lobe, with partial involvement of the right occipital and temporal lobes. Disease also crosses the midline via the splenium of the corpus callosum.