 Multiple sequences are significantly motion degraded. Redemonstrated is a large left parietal mass with thick rim enhancement surrounding the posterior horn of the left lateral ventricle. This lesion again infiltrates the splenium of the corpus callosum, crossing to the contralateral side. The enhancement is slightly decreased in intensity although the extent is not significantly changed. There is also mild decrease in the T2/FLAIR hyperintensity involving the left frontal, parietal, and the left temporal lobes also consistent with Avastin effect. Areas of T2/FLAIR hyperintensity involving the right frontal lobe are unchanged. The right posterior insula and the right superior temporal gyrus T2/FLAIR hyperintensity is stable to mildly more prominent. Perfusion rCBV map again demonstrates elevated cerebral blood volume in the left parietal region. There is also abnormal enhancement tracking along the ependymal region of the temporal horn of the left lateral ventricle as well as the body of the left lateral ventricle. The multifocal leptomeningeal enhancement seen on the previous study is less prominent, which may be related to motion degradation in the current study.There is mass effect on the occipital horn of the left lateral ventricle which is stable to minimally improved. 5 mm midline shift is also stable to minimally improved. There is mild enlargement of the ventricular system since the previous study.Small blood products are seen along the left biopsy tract, unchanged. The major cerebral flow voids are intact. The orbits, skull and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening of the right maxillary sinus.
1. Mild interval decrease in extent of T2/FLAIR hyperintensity and enhancement associated with left parietal GBM compatible with Avastin effect. 2. Again seen evidence of leptomeningeal spread of disease which is less conspicuous on this study, which may be related to technique/motion degradation on the current study. 3. Additional foci of T2/FLAIR are seen in the right cerebral hemisphere similar to prior which are nonspecific. There is minimal increase in prominence of the slightly expansile area of FLAIR hyperintensity involving the right posterior insular region and the superior temporal gyrus. This area may represent an additional site of lower grade glial neoplasm.4. Slight enlargement of the ventricular system compared to the previous study.