Male, 45 years old, history of GBM status post RT/TMZ + TMZ, also status post interval drainage of cystic fluid. Redemonstrated is an irregular, multicystic rim-enhancing lesion centered on the right thalamus, cerebral peduncle, basal ganglia and temporal stem. As before, a catheter traverses the dominant cystic component of this lesion from a right temporal approach.Since the prior examination, some of the cystic components of the lesion have slightly increased in size with progressive thickening of the enhancing rim, particularly along the lesion's posterior superior margin. In addition, small foci of enhancement seen on the prior examination extending cranially into the right superior parietal lobule have coalesced and increased in size. The enhancing components of this lesion demonstrate variable elevated rCBV.Extensive T2 hyperintensity surrounding the above-mentioned lesions is again seen involving the temporal lobe, insula, thalamus, basal ganglia, posterior right frontal and parietal lobes. This signal abnormality and associated mass effect have progressed in the right paracentral lobule and parietal lobe. There is partial effacement of the right lateral ventricle appearing similar to prior, as well as a midline shift to the left of approximately 10 mm, slightly progressed. The left lateral ventricle is mildly prominent suggesting a degree of entrapment, also slightly progressed. There may be minimal ependymal enhancement along the right ventricular atrium, but this is equivocal.
A large, multicystic rim-enhancing lesion is redemonstrated within the right cerebral hemisphere showing slight interval change in size and progressive thickening of the enhancing tissue. In addition, areas of enhancing tissue have also increased in size more cranially within the right parietal lobe. These findings are most compatible with progressive disease.