Female, 63 years old, with GBM, status post clinical investigation. Postoperative findings are again seen at the left parieto-occipital junction. The heterogeneously rim-enhancing lesion at this location has increased in size with a maximal axial dimension of approximately 50 mm, previously 38 mm. As before, the lesion extends to the ependyma of the left ventricular atrium which is progressively effaced. A small portion of the enhancing component correlates to elevated rCBV, but the majority shows relatively reduced rCBV. T2 hyperintense signal abnormality and edema within the adjacent parenchyma has progressed further into the anterior temporal lobe, temporal stem and capsular white matter, the splenium of the corpus callosum, and the superior parietal lobule. No entirely new enhancing lesions are seen. No definite contralateral involvement is detected.
There has been interval increase in size of the enhancing lesion in the left parieto-occipital junction along with progressive T2 hyperintensity and edema. These findings are concerning for progressive disease. However, given that the lesion demonstrates overall low rCBV, the possibility of a treatment related effect can be entertained. Correlation with timing and nature of treatment may be helpful.