Reason: Eval GBM. Pt Dx in 2014. Off all Tx for past year. History: GBM. Postoperative changes are again seen relating to prior left frontal craniotomy and left frontal lobe tumor resection. The mildly hemosiderin stained resection bed appears stable. There is no pathologic enhancement in the surgical bed. Specifically, a previously noted small focus of enhancement within the right superior frontal gyrus is no longer visualized.Patchy T2/FLAIR hyperintensity within the left greater than right frontal lobe white matter has progressed from prior more remote examinations, without mass-like appearance. A few scattered punctate foci of T2/FLAIR hyperintensity within the cerebral white matter remain nonspecific, unchanged. There is subtle progressive increased extent of T2/FLAIR hyperintensity along the right basal ganglia. ADC images are not currently available, to accompany diffusion-weighted images.The ventricles and sulci are prominent, consistent with moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. Incidental empty sella is again noted. The remainder of the midline structures and craniocervical junction are within normal limits. A left maxillary mucus retention cyst is again noted.
1.Stable appearing left frontal lobe surgical bed with no evidence of pathological enhancement.2.Progressive ill-defined frontal lobe white matter signal abnormality, most likely post-treatment effects.3.Gradual increased ill-defined FLAIR abnormality in right basal ganglia, which may also be post-treatment related. Addendum will be issued with ADC images are provided.