Reason: Pt w/ GBM, s/p RT/TMZ and now only on Optune. History: GBM. Postoperative changes are again seen from previous right frontal craniotomy for resection of a right frontal lobe mass. There are section cavity along the high anterior right frontal lobe appears similar in configuration, with slight decreased marginal susceptibility relating to postoperative blood products.There has been interval development of a few scattered punctate foci of diffusion restriction along the medial right lateral ventricular margin at the level of the body, in addition to nodular appearing diffusion restriction along the body of the corpus callosum. Corresponding nodular enhancement is seen along the areas of new callosal abnormality. There is now ill-defined T2/FLAIR hyperintensity across the corpus callosum, with slight increased extent of periventricular FLAIR hyperintensity along the lateral ventricles, and now extension into the right lateral temporal lobe periventricular white matter as well. There is focal nodular enhancement now along the right temporal lobe periventricular white matter measuring up to 1.4 cm. Persistent nodular enhancement is also seen along the margins of the resection cavity extending towards the ventricular wall. Other more punctate foci of enhancement are seen within the intervening white matter, for example on 1300/114 in the right lateral frontal deep white matter.
Progression of nodular enhancement and abnormal ill-defined signal across the body of the corpus callosum as well as now into the right temporal periventricular white matter suggestive of tumor progression.